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Full text of "Phthisis pulmonalis; or, Tubercular phthisis"

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Phthisis Pulmonalis 



OR 



TUBERCULAR CONSUMPTION. 



BV 



GERSHOM N. BRIGHAM, M.D., 

Grand Rapids, Mieh. 




BOERICKE & TAFEL, 

NEW YORK : PHILADELPHIA : 

145 GRAND STREET. 1011 ARCH STREET. 

London : Leath & Ross, 5 Saint Paul Church Yard. 
London: Homeopathic Publishing Co., No. 2 Finsbury Circus. 

1882. 



Copyright, Boericke & Tafel, 1882. 












INTRODUCTION. 



Numerous as our treatises upon pulmonary consumption 
may be, the appearance of this work needs no apology, pro- 
vided the author has something to say. From the homoeo- 
pathic standpoint no very exhaustive treatise has yet appeared. 
Upon histological and pathological questions, much has been 
written of late, and yet the profession have come to no agree- 
ment. 

But it must be admitted that there is quite a change of 
opinion going on among leading men of all schools, both as 
to the causes of phthisis, and the sources and character of the 
morbid products. The controversy between the followers of 
Prof. Bennett, who believes the disease to be essentially one of 
faulty nutrition, and those of Prof. Virchow, who believes the 
disease essentially one of inflammation, is far from being 
settled. 

The more recent doctrines of Prof. Rindfleisch, relegating it 
to our class of infectious diseases, does not tend to bring har- 
mony of opinion upon the subject. 

We have endeavored to present in a succinct manner the 
salient points advanced by each of these leading pathologists, 
not doubting that there may be much truth in what is ad- 
vanced by each of them, but doubting if any one of the above 
mentioned writers presents the whole matter included in the 
causes and transformations of the lesion known by the general 
term of phthisis pulmoualis. 

We have thought best to state causes in the ordinary man- 
ner of treating this subject, believing a work so handled is 
more practical, and that our indications for treatment will be 
the better mastered. For it is the successful management of 
these cases, after all, which we aim to present. 



8 INTRODUCTION. 

Without claiming that we have said all, or even the best 
that can be said, upon this grave subject, we hope that we have 
said enough to stimulate to further investigation in the direc- 
tion that we have taken; and that at no remote period, we 
shall find means within our grasp to treat effectually the dis- 
ease which has so long been an approbrium to the healing art. 

If pathology is, to a certain extent, unsettled, and the his- 
tology of the disease under review, and possibly the whole 
matter in a transition state, we, who study more the inward 
expressions of a morbific force acting upon the sentient and 
vital forces, can well wait for time to settle these controversies; 
while we more especially apply ourselves to the study and ap- 
plication of the law of cure, formulated by the founder of 
homoeopathy, to determining the best dilutions to use, and the 
frequency of their administration. 

We do not claim to have added anything to the subject of 
physical diagnosis from what may be found in text-books, yet 
it is convenient that the matter should appear here. 

The author acknowledges himself under obligation to many 
of his colleagues who have kindly given him support in pre- 
paring this work. 

Especially would he mention the late and lamented Dr. Con- 
stantine Hering as offering invaluable aid. He is also under 
many obligations to Prof. Raue for valuable suggestions, and 
to Drs. Hempel and Arndt for cases drawn from their Materia 
Medica, and to Dr. Arndt also for valuable clinical translations 
from the German; and lastly to the labors of Dr. Dunham. 
The author has tried to illustrate in his work, by reporting 
clinical cases, the types and phases of disease to which our 
different remedial agents seem applicable ; and also to show by 
cumulative evidence that phthisis has proved to a certain ex- 
fent amenable to remedies. 

G. N. B. 



PHTHISIS PULMONALIS. 



CHAPTER I. 

PRELIMINARY REMARKS. 

This disease is more frequently called pulmonary consumption. 
The word phthisis means a wasting away — a slow death. The 
use of the term more recently has, by common consent, been 
restricted to that species of wasting away which attends the 
occupation of the lungs with tuberculous matter and the 
changes in its transformation, and the destruction of tissue 
where it works. And yet this is a very inadequate definition, 
because this local phenomenon must usually be considered 
only as a fragment of a constitutional malady ; the focus where 
morbid forces concentrate and become expressed in pathologi- 
cal changes. That the lungs should become the focus of the 
tubercular deposit does not seem strange when we come to 
consider that all the blood and blood-making material has a 
constant flow into this organ, there to undergo the process of 
parting with carbon and of receiving oxygen. The blood fluid 
in all stages and conditions of purity, at high grade and low 
grade of vitality, passes into this sifting, assimilating and 
eliminating organ, to be prepared for the highest uses in the 
production of structural formation and for supporting func- 
tional activity. That portions of debris should become im- 
meshed in this net-work of cells does not seem strange. And 
that any such matter should become a source of irritation, pro- 
voking a chronic inflammation of the interstitial tissue, would 
seem natural enough. Further, that when hyperplasia of the 
parent tissue has been developed, pressure upon the vascular 

2 (9) 



10 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

vessels would follow, cutting off more or less the supply of 
blood, possibly" causing exudation from the walls of these vas- 
cular vessels and from the lymphatic glands. In defining 
pulmonary phthisis, if the lesion be confined to the lungs, as 
the term implies, we can correctly speak of pulmonary phthisis 
only when the morbid force assails the lungs, and of tubercular 
phthisis only when tubercle is deposited. 

Again, tubercle has been considered the cause of the phthisis, 
whereas it would seem to be a pathological product of a morbid 
force working in the system producing this kind of neoplasm, 
if it be a growth. It may safely be said that tubercle does not 
exist till the morbid force, or disease, is well advanced. It is 
uniformly present, however, in pulmonary phthisis of the va- 
riety of which we are speaking/ The pathological changes 
must be referred to some force affecting the correlating forces 
of the human body. And as transformations begin in mole- 
cules, no doubt the morbific agent or force is first felt in the 
molecular movements. Our understanding of vitality itself 
is, that it is a correlating energy — an energy all the time sup- 
plied by the transmutation of force ascending from the planes 
of the mineral, vegetable, and lower animal kingdom, and that 
all force is distributed from molecules. The action, then, of 
any specific virus or morbid force as well as the power of a 
drug whereby it impresses the organism, is properly spoken of 
as a mode of molecular energy. A remedy, if it does anything 
to aid vitality in its struggle against opposing forces, does so 
by imparting something of its own molecular energy, or by 
supporting the molecular or correlating energy or vitality; 
more commonly, I think, the first, foods and assimilable sub- 
stances usually yielding the last. Indirectly, the drug energy 
may do something, yes, much, by removing impediments 
which so embarasses vital energy that assimilation, which is 
a mode of correlation, is unable to go forward. 

Consumption a Curable Disease. — We hold that consump- 
tion is not incurable so long as vitality can be made to take a 
more self-asserting influence in the tuberculated tissue than 
that of degrading chemical forces. Consumption is cured by 
aiding nature to convert the albuminous exudation into fat, so 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 11 

that it can be absorbed — by controlling inflammation which 
leads to the breaking down of structure ; by tubercle becoming 
encysted and non-irritating ; by tubercle becoming cretaceous 
and no longer subject to softening; lastly, by tubercle soften- 
ing and being expectorated through the tubular passages, ab- 
scesses and ulcers closing by cicatrization. 

It is not an easy disease to cure, and when the graver lesions 
are set up, serious doubts of recovery must be entertained. This 
may be said of all the graver diseases, that they reach a point 
where vitality is so overwhelmed that a majority of cases will 
succumb in the struggle. 

However, consumption must be classified among our most 
fatal diseases. It being usually a slowly developing disease, 
the case often gets well along before the attention of the physi- 
cian is called to the patient's condition. The opinion, also, of 
medical men upon this disease, usually disarms them of all 
means to help in the case. Indeed, medical men are very apt 
to overlook an incipient phthisis and let it run along well into 
the second stage, tubercular stage I mean, before they recog- 
nize the true condition of things. This is most unfortunate, 
for the successful management of our consumptive cases, de- 
pends largely upon early recognition, and prompt attention to 
dietary management, good air, proper clothing, possibly change 
of climate, and lastly, to efficient medication ; we mean by the 
administration of the true homoeopathic agent, and in such 
dilution as to call into activity healthy morphic movements 
in place of morbid. 

The Function of the Lungs. — Have we given sufficient 
importance, in the study of caseous accumulations, to the fact 
that the lungs receive all the venous blood in the system, to- 
gether with the blood-making material from the digestive sys- 
tem, in a constantly inflowing stream, performing at the same 
time the function of discharging carbons and other matters, 
and taking in oxygen ? The double function of elimination 
and assimilation being here carried on, it follows that there 
must be much debris in a workshop of such activity and ca- 
pacity. It is easy to see that very great activity in the clear- 
ing away process will be constantly demanded — that any re- 



12 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

tarded movement in the drift, tends to load down any portion 
of the lung where the movement is slowest ; this would proba- 
bly be in the apices where cheesy exudation usually occurs. 
Whether a blood-stasis here becomes the iniative step to the 
exudative process termed cheesy pneumonia by our German 
friends, and caseous exudation by Bennett and his followers, 
it may be proper to enquire. Possibly, here may be the ele- 
ments of irritation in portions of the lung where such detritus 
remains, operating from within the vessels, as the dust of fac- 
tories and other work-shops operate without, each provoking a 
sufficient amount of inflammation to cause albuminous or fib- 
rinous deposit from the vascular vessels. Such detritus might 
be compared to the moraines in the drift of a glacier or the 
sediment of a river. It is easy to see that any cause operating 
to degrade force here would become an active agent in bring- 
ing on a tuberculosis ; its might be heredity, scrofula, malaria, 
mercury, alcoholism, bad air, excessive venery or any specific 
poison. The importance of the function of the lungs and the 
amount of matter that must pass into the vessels, small and 
great, in these organs is really of a nature to astonish. The 
wonder is that they remain healthy so long. To keep them 
clear of obstructions must be a very important part of our 
treatment of persons becoming enfeebled from any cause. 



CHAPTER II. 
CAUSES OF PHTHISIS. 



First, predisposing causes. In a general way, I think we 
may say that any force tending to degrade vital force may be 
a cause of tubercular degradation of the elements of nutrition, 
and hence a factor in any given case of phthisis. But it may 
be accepted that the same force would be active in developing 
tubercle in one person and not have any apparent effect in 
that direction in another. 

Constitutional conditions then play an important part in the 
history of tubercle, and, of course, in pulmonary phthisis. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 13 

Among these causes we may mention, first, hereditary trans- 
mission of impaired vitality. And from this impaired vitality 
we get a neoplasm called tubercle. Why this morbific force 
expresses itself in tubercular degradation we know not any 
more than we know why measles or whooping cough have 
their own peculiar workings in the vital economy. It seems 
proper to say that we are not able to explain the first cause of 
a phthisis coming through heredity, a cachexia, or otherwise, 
till investigations are able to eliminate some poison, germ, 
force or forces, capable of diverging the lines of morphology, 
first, in embryo, and. peradventure through the entire period 
of life. It may be that the menace to life comes as much from 
conformation, which is largely hereditary, as from a deterior- 
ating force which degrades the plasma, or works through nu- 
trition, and then nutrition lies behind growth. Most of us 
agree that the germs of tubercle, or the conditions favoring 
the production of tubercle, are often hereditary. And yet, pos- 
sibly, too much stress has been laid upon the hereditary bias. 
Again, many regard that phthisis is communicable from con- 
tagion or infection. Especially is it believed that a latent tu- 
bercular habit is quickened into activity by being associated 
with active phthisis in the ulcerative stage. We have had 
cases which seemed to support such a theory. These facts 
tend to show something specific and of its own kind, in the 
morbid force of tubercular phthisis. But phthisis has seemed 
almost as clearly to have come from other sources as from this 
hereditary element. It can hardly be doubted but that it has 
come of other transmitted morbid states, such as, for instance, 
arise from alcoholism and syphilis. We have known a family 
where both parents lived to an advanced age, dying of old age, 
when four out of six of their children died of consumption be- 
tween the ages of thirty and fifty, the only cause to be conceived, 
being that both parents were intemperate. Then may we not 
have a phthisis engrafted upon the constitutional taint of a 
syphilis or gonorrhoea? Our predisposing causes are chiefly 
the different cachexias. First among these is the scrofulous ; 
then follow the syphilitic and sycotic cachexias and alcohol- 
ism. Alcoholism, impresses the vitality to a degree to destroy 



14 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

largely tlie viability of offspring. I would recognize an alco- 
holic cachexia and put it well forward as a predisposing cause, 
both in the intemperate themselves and in their children. 

Would it not be as proper to speak of scrofula as hereditary, 
sycosis, syphilis and alcoholism as hereditary, and phthisis as 
a mode of death or advancing degeneration of different morbid 
forces with their focus planted in the lung tissue, the early 
pathological expression of which is found in tubercle and ca- 
seous exudation ? It will be objected, no doubt, that the mor- 
bid force which produces tubercle is sui generis and unlike 
anything else. Well, we do not know its parentage, if such 
an individuality really exists. Reason as we will, we have to 
treat certain pathological conditions, and to overcome a morbid 
force acting in a very dangerous and pretty uniform way upon 
the life forces. Perhaps this method of study will best help in 
doing it. We generally speak of scrofula as the root out of 
which consumption sprouts. But scrofula is often the offspring 
of syphilis, sycosis and alcoholism, to say nothing of bad air, 
bad food and many other things which undermine the vital 
energies. The rule is, we confess, that specific poisons tend to 
propagate their like — syphilis a syphilitic taint, gonorrhoea a 
gonorrhoeic, etc. And yet, after a little, these poisons do be- 
come changed, and a scrofulous condition is apt to follow. I 
think it is pretty safe to say that anything which tends to de- 
stroy the- life and coherency of the blood corpuscle, tends also 
to phthisis. So that, although every morbific force may have 
something of its own kind differing from anything else, yet, as 
it carries with it a slow decay, something which deteriorates 
the vital force, this molecular death, or corpuscular degrada- 
tion, shows itself very commonly in a final relegation to chem- 
ical laws in the lungs. To continue our discussion, we will 
name a few causes not so remote. 

Food. — Improper and insufficient food is no doubt an im- 
portant factor in blood degradation, and through this avenue 
a cause of phthisis. When, for any length of time, waste ex- 
ceeds supply, we may look for pulmonary troubles. Emacia- 
tion is one of the first indications of a pulmonary phthisis. 
We have noticed that many of the disciples of Dr. Graham die 
of consumption. Poor food furnishes only poor blood. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 15 

Bad Air. — Living in clamp unwholesome tenements, and 
breathing bad air, rapidly deteriorates the blood; and this, 
conjoined with bad food, is well known to develop tubercle. 

Breathing bad air in badly ventilated rooms and churches, 
school houses and factories, has no doubt much to do with the 
mortality from consumption. 

Malaria. — Malaria being capable of making a permanent 
lodgment in the system, may be said to develop something 
akin to cachexia. Many cases of phthisis seem to spring up 
out of the soil impregnated with malaria. 

Exanthemata. — Some of the exanthemata have the power 
to degrade vital movements to the extent of preparing the way 
for a tubercular deposit. Especially may this be said of 
measles and small-pox; and then it holds true of some of the 
chronic forms of skin diseases. Perhaps these may as often 
be exciting causes as predisposing causes. 

Marriage. — Conformation of the chest, as well as high grade 
of vitality, are usually derived from ancestry. The narrow 
chest can often be obviated by careful conjugal selection. 
Menace to life through pulmonary tendencies will be very 
sure to follow a marriage where both father and mother are of 
consumptive habit. The laws of atavism and variability no- 
where need to be more carefully studied than in relation to 
the subject under consideration. 

Climate. — The last cause which we will mention is climate. 
There is little doubt that climate has much to do in forming 
physical and mental types of the people living in it. 

Conformation, habits and mental and moral peculiarities 
largely originate in climate. Even man's food is modified by 
it, as well as his dwellings, clothing, and many other essentials 
of life. Some have said that consumption was the offspring of 
civilization. Dr. Livingstone says that pulmonary consump- 
tion scarcely exists among the natives of interior Africa. 

This tends to show that living largely in the open air, and 
according to primitive customs, obviates tubercular tendencies. 
A climate subject to sudden changes, no doubt, is a cause of 
congestion of the lung tissues; and this is followed by inflam- 
mation, and inflammation is followed by tubercle. Where 



16 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

climate has favored the highest civilization, we have the most 
consumption. Consumption among civilized communities, 
however, is not more in consequence of climatic influences, 
than incident to the industries of this civilization. 

EXCITING CAUSES. 

At the head of these we place dust-particles of various kinds ; 
woolen and cotton fabrics, wood and steel furnishing the 
largest per cent. Autopsies are beginning to show us how 
numerous are lung diseases apparently provoked from what is 
breathed into the lungs. The dust which is flying in our 
workshops is even worse than the heated air deprived of its 
oxygen. All these foreign particles tend to irritate the mucous 
membranes and develop an inflammatory condition of a sub- 
acute character, which sooner or later, brings on hyperplasia 
of the tissue, the next step to cheesy exudation. The mortality 
among the operatives in the woolen and cotton mills of New 
England goes to confirm our theory. It may be well to inquire 
here, if the carpets upon our floors, especially the cheaper and 
more loosely-woven grades, should not be condemned on sani- 
tary grounds. The amount of dust arising therefrom which 
is taken into the lungs is probably much greater than we are 
aware of. 

Some of our cases of pneumonitis have their origin in the 
irritation caused by foreign substances; that these and pneu- 
monias badly managed are at the bottom of much of the con- 
sumption in Massachusetts, we think, hardly admits of a doubt. 
Inflammation often ends in contraction of the lung tissue, and 
contraction favors caseous condensation. 

We have known such irritation and chronic inflammation 
to follow from the lodgment of a foreign body at the bronchial 
bifurcation that pulmonary phthisis followed. 

The consumption of needle-grinders is but too well known. 

Exhausting Drains upon the System. — These are of the 
character of overwork of mind and body; too prolonged lac- 
tation; too frequent conceptions; excessive venery, marital, 
illicit and solitary. Typhoid fever, caries of the bones and old 
abscesses may be added to the list. 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 17 

Nervous Shock. — The effects of disappointment, ceaseless 
anxiety, remorse of conscience, and inconsolable grief, no doubt 
have been the exciting causes to a pulmonary phthisis; who 
of us has not seen such victims from cruel and harsh treat- 
ments, and from heart-breaking disappointments. 

Catarrh. — It hardly need be said that a cold often leads to 
a consumption. Very commonly a chronic catarrh produces 
hyperplasia of the mucous membranes and of adjacent tissues. 
This produces pressure upon the vascular vessels, and cuts off 
more or less of the blood supply. In this pathological state 
albuminous or fibrinous exudation is apt to follow, giving us 
the cheesy deposit. This is thought by many to be a fertile 
source of pulmonary phthisis. 

Pneumonitis. — Inflammation and occlusion of the alveoli 
offer impediments to such supply of air as is necessary to the 
changes which must be made to supply the system with good 
blood ; it is easy enough to see that we must have here an ex- 
citing cause. Improper aeration means bad blood; obstruction 
in the capillary vessels means opportunity for the loading 
down process from stasis of the blood, and then the sowing of 
debris in inactive lung tissue. Inflammation continued means 
hyperplasia of the parent tissue, pressure upon the vascular 
vessels, and a field favorable for the sowing of tubercle: Fre- 
quent pneumonias are apt to end in pulmonary phthisis. 

Hsemoptysis. — Haemorrhages of the lungs are often the 
first indications of a pulmonary phthisis. They often arise 
from tubercular lesions. Again, they occur from other causes, 
and tubercle is finally sown in the soil which has come of un- 
absorbed matters, injuries to vessels or fracture of tissue, fol- 
lowed by interstitial pneumonia ; the end being a consumption. 
Yet probably in most of these cases we will find a previous 
tendency to morbid action of which the haemoptysis is only a 
symptom announcing the danger. 

Menstrual Derangements. — The end of a chlorosis, the 
dangers of an anaemia, and the troubles which may arise from 
a suppression, have long been well understood. It is not too 
much to say that a uterine catarrh from its exhausting and 
deteriorating effects upon the one hand, and the possibility of 



18 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

a metastasis to the lungs on the other hand may become an 
exciting cause to a pulmonary attack with tubercle associated. 
Some of these causes will be considered more in detail here- 
after. 

To conclude this part of our discussion, we say, then, that 
the causes of phthisis are various. It may spring out Of a root 
so permanently planted in the organism as to be transmissable 
by hereditary laws. It may arise from cachexias that under- 
mine the system and form a soil for the sowing of tubercle. It 
may arise from accidental causes, no previous taint having 
affected the system. 

In other words phthisis may be constitutional and heredi- 
tary, or accidental. Accidental phthisis, once developed, no 
doubt, often becomes transmissable, and tends to permanency 
in structural transformations. 

LEUKAEMIA. 

The decrease of red blood corpuscles and increase of the 
white corpuscles may have much to do with the caseous exuda- 
tion; the white corpuscles are composed chiefly of albumen, 
and the fact that they fail to become red corpuscles, or that a 
red corpuscle loses the coloring matter, indicates an arrest in 
the advance of albumen toward a state favorable to healthy 
tissue -transformation. In other words, when it leaves the 
blood-vessels it is in a condition of low vitality, with a tend- 
ency to retrogarding transformations, such as to fatty degene- 
ration, salts of soda and lime, which are the constituents of 
tubercle. May we not properly call this condition a hyper- 
albuminosis or hyper - fibrinosis of the blood; the cause trace- 
able to faults of secondary assimilation? This diathesis is 
often called strumous, because of the tendency to glandular 
enlargement; what particular function the glands may have 
in elevating albumen to structural fitness may be a question; 
but the tendency of the glands to hypertrophy and to take on 
inflammatory action in leukaemia is fully admitted. Whether 
tubercular infiltration is the product of a lymphangitis may 
be a question for pathologists to settle hereafter. It was claimed 
at one time that the matter called tubercle was no more nor 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 19 

less than white corpuscle extravasated into the tissues. It is 
held still, that tubercle is exudative matter of an albuminous 
character, thrown out from the vessels as tissue -matter with a 
low grade of vitality, and hence with a tendency to degrada- 
tion to a lower plane, such as earthy matters and fat. It is 
pretty generally agreed that red corpuscles become diminished 
in connection with tubercular deposit ; and as this expresses a 
low grade of vitality, it favors exudation. It may be a question, 
however, if this be not one of the primary pathological changes, 
and more of a symptom than an element of causation. If so, 
we would still have to go behind for the element, or elements of 
causation. Further, it may yet be considered debatable ground 
as to whether tubercle is deposited from vessels which carry 
structure -building material forward for tissue alliance, which 
alliance fails because the material is of too low vitality, or 
whether after all it is deposited from vessels conveying from 
the system rejected matter, moving under chemical law, which 
in the form of excreta, in one way and another, is drifting to 
a lower plane, and tends to move out of the system. It is claimed 
by as respectable authority as Dr. Prout that a tendency to 
assume the crystalline form, is evidence of matter being of the 
character of excreta, which must be rejected from the system. 

It is conceded by all, that the lungs are one of the emunc- 
tories, and carry large quantities of rejected matter from the 
system. 

There is no doubt but that tubercle takes the chemical di- 
rection in transformation and tends to enter into the crystalline 
form. Whether our opinions are to undergo any change here- 
after, remains to be seen. That tubercle once deposited must 
be treated as a foreign substance needing to be absorbed and 
thrown out of the system as excreta is very clear; nor do I 
think that we can successfully contend against the position 
that tubercular deposit is a pathological product. 



20 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

CHAPTER III. 
THEORETICAL OPINIONS UPON TUBERCLE. 

Two theories upon the histology and pathology of tubercle 
prevail; one of the English and one of the German school of 
pathologists. Professor Hughes Bennett may be said to head 
the English school, and Flint and Reynolds adopt his opinions 
into their text-books. 

This theory holds that the tubercular exudation comes of a 
low form of histo-genesis, originating out of some dyscrasia 
that deteriorates the blood, and that the cheesy tuberculous 
matter is thrown out from vascular vessels into the interstices 
of the parent tissue, where it undergoes transformation. We 
quote the Professor's own words: "With regard to its mode of 
production, tubercular matter is first separated from the blood- 
vessels as a fluid exudation, forming by its first coagulation a 
molecular blastema. The molecules of which it is composed 
then aggregate or melt into each other to produce the tuber- 
cular corpuscles. These, if compressed together and formed 
slowly, constitute the dense granulations described by Bayle ; 
but, if separated by soft molecular tissue, produce the more 
common yellow tubercles." 

The other theory, which is championed by Virchow, and 
adopted in Niemeyer's Theory and Practice, regards tubercle 
as a new growth and as the outcome of cell-proliferation. 
Reginald Southey presents the following doctrines as express- 
ing the views of German histologists : 

"Tubercle is a new growth belonging to the lymph tumors, 
constructed after the pattern of lymph glands, and standing 
in closest relation to connective tissue formations. The single 
tubercular, or tuberculous tumor, is not capable of identifica- 
tion from any one element entering into its composition ; but 
its origin, its development, and its minute structure, together 
confer a particular stamp upon it as a whole, which renders it 
capable of distinct recognition. The tubercle formation is cell- 
structured from the moment of its first appearance; it proceeds 
always out of connective tissue, or from some tissue closely 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 21 

allied to this, such as false membrane, fat, or the medullary 
tissue of bone. It exists in two forms, the one the cellular, the 
other the fibrous form ; but they have such features in common 
as imply unmistakable oneness. The fibrous form is only a 
slight structural modification of the simple cellular— a modi- 
fication impressed upon it by the external conditions of growth. 
The origin and mode of development of the simple cellular 
form is best of all to be studied from the tuberculous growth, 
as this is found upon serous membranes, or upon the mucous 
membrane of the larynx. This young growth here is smaller 
than a millet seed; has a granular look, and contains soft, im- 
perfectly developed cells, which are easily broken down, and 
also free nuclei. Its elements are identical with those that 
constitute a normal lymph gland, although differently grouped. 
This isolated tubercle forms the tiniest tumor that occurs on 
the human body, but it is rarely, if ever, single. These growths 
are found in nest-like groups, close together, and multitudes 
of nodules, originally and individually distinct, combine to- 
gether and form a conglomerate tumor." Caseous or cheesy 
exudations, which are believed to be usually the result of 
chronic catarrh, are spoken of as gland tumors of a scrofulous 
nature, or the outcome of scrofulous hepatization of the lungs, 
which is thought to be distinct from the tubercular neoplasm. 

Dr. Southey goes on to say: "The catarrhal process extends 
into the air-cells, the appearances finally obtained being 
scarcely distinguished from those which attend acute pneumo- 
nia; catarrhal mucus cells and fibro-plastic ovoid nuclei are 
mixed together and block up the alveoli; the inter-vascular 
spaces are trebled in thickness (" hyperplasia "), and come to 
present a dense and more or less fibrillated connective tissue." 

The disciples of Virchow thus make a distinction between 
what they call caseous pneumonia, and the tubercle found 
upon serous and mucous surfaces. 

The caseous exudation, so often found in the apices of the 
lungs, they speak of as a mucous cast of an air-sac; and the 
diseased action by the term caseous pneumonia, reserving for 
the diffuse, millet-sized neoplasm the term tubercle. And 
yet, consenting and affirming that the adventitious product 



22 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

called caseous exudation or mucous cast, produces in softening, 
cavities and destruction of the lung. They say: "It is an ad- 
ventitious product; it is the result of a local inflammatory pro- 
cess, true enough. It is deposited from the blood, and coagu- 
lates in the part where it is found; softens into a cheesy mass 
from the center. It almost plugs up the smaller bronchi ; 
death follows from pressure and cutting off nutritive supplies." 

Now there is much to be said in favor of making a distinc- 
tion between pulmonary phthisis developing out of inflamma- 
tory action, such as a catarrh, a pneumonia, and the irritations 
arising from dust of one kind and another, as well as other 
accidental causes, and the disease known as scrofulous pulmo- 
nary phthisis, or the phthisis arising from faults of nutrition, 
as the English school would make all cases of phthisis to arise. 
Much stress is laid upon this histological and pathological 
disagreement of the two schools by James Henry Bennett, 
bearing upon the treatment of phthisis. One believing the 
disease to arise from defective nutrition, from which we get a 
low form of histo-genesis represented in these coagulated ex- 
udations from the blood, while the other considers them new 
growths of a fibrous or cellular form, developed out of the con- 
nective tissue, and resulting from irritation and inflammation 
largely, it follows that the treatment is likely to be very un- 
like. This, indeed, has much significance from an old school 
stand-point, but it will not be likely to trouble the homoeo- 
path much, as he is to give the similissimum in any event. 
The histology of tubercle, then, is hardly a settled question. 
And for the present work, we, with the French physicians, 
shall accept both theories in part, not admitting that either 
party, or both parties combined, have yet learned, pathologi- 
cally and histologically, all that is to be learned of the disease 
known as pulmonary phthisis. 

Hitchman affirms that consumption is primarily a disease 
of the nervous system: "A derangement par excellence of the 
nerve globules;" the steps in tuberculosis proceeding in indi- 
gestion, and consequent mal-assimilation of the food and im - 
poverishment of the blood, accompanied with an excess of 
acidity in the alimentary canal, the final fact being tubercular 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 23 

deposit. Now, this seems to me to be as far from answering 
the question as any other theory advanced. It may be doubted 
if nerve-waste be any earlier involved in the retrograde meta- 
morphosis than some other of the tissue elements. Albumen 
is found in exceptional proportions in the composition of nerve 
globules; and this being the fact, it is not easy to see why 
that particular structure should be the first to suffer, with this 
excess of fibrin or albuminoid matters flowing all the time in 
the blood to the brain. 

It may be said that it does not come in a condition to be 
correlated, or allied, with structure. If that be the fact, it goes 
far to prove that we must go behind this hypothesis for the 
first cause. 

Though pathology, so far as it affects treatment, is of less 
importance to a homoeopath than an allopath, yet it might 
modify both his treatment and prognosis, if he should decide 
that a phthisis began as a lymphangitis, and from it we had 
hyperplasia of the connective tissue the same as we get hyper- 
plasia in other organs where the inflammation extends from 
the mucus membranes to the parent tissue or to fibrinous struc- 
tures. Hyperplasia of the parent tissue really seems to be one 
of the early pathological changes in tubercular phthisis. It is 
prepared ground for the sowing of tubercle. A lymphangitis, 
or even a hyperplasia of the areola tissue would be held by 
most of our physicians, no doubt, to be curable; the diathesis 
in a pulmonary lymphangitis to be considered, as in treating 
a disease of the kind elsewhere located. The hereditary fea- 
ture of the disease, should not preoccupy our minds to such an 
extent as to have us yield our ground without a battle. 

With our homoeopathic remedies we may expect to neutral- 
ize even the hereditary element, in some sense. Admitting 
this disease to be of a nature subtle enough to work among 
the molecules, and to degrade protoplasm, we have agents as 
subtle in our list of potentized drugs. Recognize the morbid 
force as something working against vitality, something arrest- 
ing and degrading the correlating energy within, which we 
will term organic correlating force, or life force, and we, above 
all physicians, are prepared to grapple with this something 



24 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

which so successfully eludes the scalpel and the microscope. 
We have the language of the mind and the entire nervous 
centers, as well as every objective symptom, to guide us to the 
character and seat of our enemy. 

REVIEW OF PATHOLOGICAL AND HISTOLOGICAL 

THEORIES. 

That a majority of our cases of consumption are not the re- 
sult of neoplasm (tubercle), but of inflammation, as Virchow 
says, such authors as Niemeyer, Guttman and others agree to, 
and the French pathologists seem to lean that way. This is 
Niemeyer 's language : " The knowledge that a majority of cases 
of consumption are not the result of neoplasm, but inflamma- 
tion, and that when tubercles exist in phthisical lungs, the 
tuberculosis is almost always preceded by a pneumonic process, 
which, by caseous degeneration of its products, has prepared 
the soil for the growth of tubercle, has been of material assist- 
ance in explaining the etiology of consumption. Numerous 
well established facts, which had hitherto defied all interpre- 
tation (as long as consumption was always a neoplasm), are 
now fully reconcilable to the generally acknowledged laws of 
pathology. Predisposition to pulmonary consumption, or to 
speak more precisely, the predisposition toward pneumonia 
terminating in cheesy infiltration, is strongest in persons of 
feeble and delicate constitution." 

After saying that croupal pneumonia, whooping cough and 
measles, may all end in caseous infiltration, that delicate and 
ill-nourished subjects have a peculiar liability to pneumonia, 
that the inflammatory derangements of nutrition occurring 
under such conditions give rise to a profuse formation of young 
and indeterminate cells which are of a perishable nature, he 
adds: "The main points of the subject may be summed up as 
follows : The consolidation and destruction of the lungs, which 
form the anatomical basis for consumption, are usually the 
products of inflammatory action, and the greater the quantity 
of cellular elements collected in the vesicles, and the longer 
the duration of inflammation, so much the more readily will 
pneumonia lead to consumption, since these are the conditions 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 25 

most favorable for trie production of caseous infiltration. Sec- 
ondly, pneumonia resulting in caseous infiltration occurs most 
frequently, but not exclusively, in puny, badly nourished sub- 
jects. This is partially because all inflammatory nutritive 
disorders by which they may be affected show a tendency to 
copious cell formation, with subsequent caseous degeneration." 

The scrofulous diathesis he makes to be a tendency to hy- 
perplasia of the lymphatic glands with profuse cell prolifera- 
tion. This brings us nearly to the point where tubercular 
exudation should properly be called the product of lymphan- 
gitis, phthisis a glandular hyperplasia with exudation into 
the connective tissue. The tubercular phthisis of Virchow 
would seem to be a disease of the glands, and caseous pneu- 
monia the real disease of which our pulmonary patients 
usually die. 

This view has the merit of simplicity of statement, and 
there are many analogies to support the theory. 

The question whether consumption comes from inflamma- 
tory action, as Niemeyer and Virchow affirm, or from the 
non-inflammatory (are we sure that ansemia is opposed to 
inflammation?), as John Hughes Bennett and others affirm, 
does not so much concern the homoeopath to know, for his 
treatment will ever be to meet the law of cure; his remedy 
coming through the pathogenesy of the drug; and this he will 
support by hygienic measures. Perhaps his cases will be 
more intelligently studied if the inflammatory or non-inflam- 
matory theory can be settled, and yet it is hardly to be made 
a vital issue. If his case come to him with a dyscrasia, he 
should recognize and treat it as an all-important modifying 
cause, be it what it may. 

That we often have to go behind all facts which pathological 
study reveals to the vital force itself, and to primary molecular 
movements to find causes, seems to us well settled. 

,The Why? is not to be answered as yet; not even Where? 
and When? the first divergence from progressive morphology 
begins. We are of the opinion that we should keep pneumo- 
nia distinct in our nomenclature of diseases from tubercular 
phthisis. We do not believe pneumonia to be a hereditary 
3 



26 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

disease, but the scrofulous or tubercular diathesis we do believe 
to be hereditary, and with it phthisis pulmonalis of the scrofu- 
lous type. We do not believe pneumonia to be a contagious 
disease, nor that it has any germ by which a woman bearing 
children from a husband affected with pneumonitis, even if he 
have hepatization, can be inoculated with the germs of the 
disease; and yet we hold that tubercular phthisis can be 
transmitted in both of these ways, that is, by child-bearing 
and by infection from sputa. Nevertheless, we do believe that 
we may have pneumonitis, degenerating into a pathological 
condition which yields the cheesy product, and out of it will 
open up fatal cavities in the lungs, tubercle being a concomi- 
tant. It becomes a phthisis in final transformation and deg- 
radation of the adventitious matter, though probably lacking 
the element of propagation, so far as the pneumonitis is con- 
cerned, at least. 

We have no hesitation in saying that a large per cent, of 
our fatal cases dying of what is called consumption begin in 
pneumonia, or chronic catarrh. Such cases come to us from 
our factories, our coal workers, stone-cutters, needle-grinders 
and other occupations; of inflammations from irritating sub- 
stances carried upon the lungs in respiration, the inflammation 
ending in thickening the connective or areolar tissue, and de- 
veloping a fibrinous mass which is the best of soil for tubercle 
if not the chief and only cause of tubercle. Consumption is 
also the result, oftentimes, of a prolonged catarrhal inflamma- 
tion of the bronchi, when it is doubtful if tubercle be present 
at all. Perhaps we more often have bronchial dilatation and 
bronchiectatic cavities which become reservoirs for secretions 
to undergo purulent changes; and a bronchiectasis is only a 
little less grave than a cavity following tuberculous infiltration. 
That we should give most important heed to catarrhs and 
pneumonias, as sources of fatal troubles of a pulmonary char- 
acter, seems to me no one can question. Especially should 
one be on the alert for an attack of chronic interstitial pneu- 
monia if the gravest termination of our cases is to be avoided. 
Call this pathological condition pulmonary phthisis, if it will 
provoke any more energy in treatment. It, at least, is an 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 27 

almost universal concomitant. Then, again, we cannot too 
strongly emphasize the dangers which arise from any cause 
which tends to provoke an ansemic state and derange the pro- 
gressive morphic movements; such as onanism, venereal ex- 
cesses, intemperance, immoderate study, too severe an applica- 
tion to business, excessive lactation, drains from leucorrhceas, 
etc.; for it is idle to say that consumption, as it is understood 
by a majority of the profession and people, does not come of 
each and all of these causes, and, so far as we can judge, 
independent of hereditary bias. Then, claiming, as we do, 
something individual, and of its own kind, for ' scrofulous or 
hereditary tubercular phthisis, nevertheless, there come to us 
from many causes, cases which are attended with caseous de- 
generation, going through with all the stages of transformation 
which attend tubercle associated with the scrofulous diathesis. 

INFECTION AS THE SOURCE OF TUBERCULAR 
INVASION. 

The theory of Professor Rindfleisch, of Wurzburg, Germany, 
that tuberculosis is essentially an infection-disease, is not alto- 
gether unworthy of our consideration. Rindfleisch bases his 
theory largely upon the fact that numerous experiments by 
vaccination with the tubercle-virus taken from the human 
species works upon animals, and he accounts for the fact that 
it does not take in a large per cent, of the genus homo, claiming 
from this, the latter have obtained immunity by quasi habi- 
tuation. These are his words : 

" Originally tuberculosis probably was a similar infection- 
disease as we find syphilis to day. Perhaps it was more viru- 
lent. It possessed, and possesses even now, the faculty of being 
transmitted from parents to children. By such transmission 
the tubercle- virus became more and more diluted, but at the 
same time it gradually became the property of mankind, and 
thus by its heredity acquired a certain immunity to outside 
infection." There is no doubt but that there is an element of 
infection at certain stages of tuberculosis, but whether the in- 
fective power is gained by transformation of the elements or 
be an anterior fact, may be a question. Is infection a proper 



28 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

term to apply to hereditary transmission? He goes on to say: 
" Tuberculosis shows itself in that peculiar course, taken by 
certain inflammatory processes, produced by moderate stimuli." 
"A tubercular inflammation may be considered: 

1. "The disseminate miliary tuberculosis; where we find in 
most organs of the body miliary and submiliary nodules. It 
is the typical eruptive form of an infectious general disease, 
similar to the efflorescence of pustules in variola. 

2. "A more localized miliary tuberculosis; where a solitary 
organ remains the chief seat of the eruption, and of the accom- 
panying inflammation, whereas all other organs are relatively 
slightly affected. 

3. " It may also be considered as localized miliary tubercu- 
losis: where around an inflamed spot of the organ we meet 
more or less miliary tubercles, they finally enter themselves 
into the composition of the. inflammatory focus, and eventually 
form the great mass of the entire infiltration. Genuine phthisis 
tuberculosa. 

4. "Inflammatory processes, especially ulcerations of a slow 
course with a decided tendency to intervals of rest, or with a 
total cure, where we have no, or barely any, local development 
of miliary tubercles, but nearly without exception tuberculosis 
of the lymph-glands. Chronic caseous and scrofulous inflamma- 
tions. 

"All such manifestations of tuberculosis must be considered 
as inflammations, whereby the tubercle-poison acts either as 
the sole inflammatory stimulus, or where it, in connection with 
other stimuli, especially mechanical, causes a local inflamma- 
tion, such being localized tuberculosis. Considering the part 
which the miliary tubercle plays in the inflammatory processes, 
we naturally surmise that we possess in it a real specific pro- 
duct of tuberculosis; where the tuberculosis appears without 
admixture, and where it presents itself as the first and sole 
manifestation of an infection with tubercle-poison, we always 
meet it in this form." 

We get the idea from reading the professor's article, that he 
would regard the entire race either as having nearly worn out 
the tubercle-virus, or carrying in them the infection, only 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 29 

latent because no adequate stimulus has yet provoked it into 
activity. Persons are only immure, after all, by keeping up a 
good nutrition and a good quality of blood. A strong point 
of danger, the professor thinks, is from auto'-infection, and we 
must admit the full force of such danger, especially as bearing 
upon pharyngeal, laryngeal and broncho-tracheal complica- 
tions. No doubt tubercle multiplies by infection even in the 
lungs and mesenteric glands. It is satisfactorily proven that 
the human species can be inoculated from the tuberculosis of 
the bovine species, but it does not seem to be histologically the 
identical disease known as tuberculosis in the human species. 
Whether it be the original from which human tuberculosis is 
descended, may form the subject of an important enquiry; it 
is very fatal and rapid in its course. The question, whether, 
or not, tubercular phthisis is essentially an infectious disease, 
must at least be considered open for further investigation. 

I am pretty sure that we have cases of phthisis from the 
effects of alcoholism, and from other causes not infectious. 
Alcoholism operates to work a slow death of the spermatozoa, 
and anything which tends to destroy life in the germinal state 
tends to develop a phthisis in the end, and the lungs more 
than any other organ, will be the seat of such morbid changes. 
Some have broached the theory that spermatozoids are only 
leucocytes or parent cells; that really this necrosis begins with 
the decay of parent cells or leucocytes; and this is getting 
pretty near to primary work. 

Evidences seem to prove that phthisis pulmonalis is a disease 
of civilization, and of more recent origin than the theory put 
forward by Professor Rindfleish would indicate. Livingstone 
states that the natives of Africa know nothing about the dis- 
ease. It must be remembered that the theory of infection is 
gaining ground as applied to very many diseases at this time. 
Chicken cholera, diphtheria, glanders and other diseases, are 
proved to be infectious. The infection does not often go to the 
extent of being reproduced in offspring however. 

In bringing under the tuberculous habit the processes of 
cheesification, the formation of atonic ulcers, and other morbid 
forms akin to these, by which the phenomena of the morbific 



30 PHTHISIS PULMONALIS I TUBERCULAR PHTHISIS. 

force becomes widened, is, we are inclined to think, sound rea- 
soning. On the whole, Professor Rindfleisch has done the 
profession good service in calling their attention to this sub- 
ject, and it may help us to a more thorough knowledge of this 
dreaded disease. 

When our catarrhs, pneumonias and malarias run on into a 
phthisis, he would have it that they provoked an inflammatory 
action, which awakened the tubercle-virus in a constitution 
not immure. 

Heubner, of Leipzig, in speaking of phthisis of the respira- 
tory organs, says : " It may appear difficult to extirpate rooted 
ideas on a disease of daily occurrence, but the doctrine of the 
infectiousness of tuberculosis clears the way to the understand- 
ing of a unity of tuberculosis. All manifestations found in 
the respiratory organs in phthisis can be derivated from one 
cause, the tubercular poison, whether it be a catarrh of the 
apices, a cheesy infiltration, a hsemoptoe or a phthisis origin- 
ating in a pleurisy. We deal therefore with an infectious dis- 
ease, produced everywhere by the same poison. Thus we un- 
derstand many a thing in the semiology of phthisis, which 
was formerly not clear." To what extent this theory of propa- 
gation by infection will be accepted by the profession, time 
will tell. There is a tendency to increase the number of our 
infectious diseases. Life is propagative and death is propaga- 
tive and alliances are with likes. Like begets like. The retro- 
grade metamorphosis once having set in, it has a tendency to 
carr} T molecular movements in that direction. If the transfor- 
mation become rapid, we say it is virulent. And like the 
leaven in yeast, the fermentation goes on about its work, and 
the greater the activity the greater the power to engraft and 
propagate. Whether phthisis is infectious until the stage of 
active transformation of tissue sets in, may be gravely ques- 
tioned. Even small-pox is not infectious until the pustules 
fill, nor diphtheria until chemical action in the exudation 
begins. 

This theorj 7, no doubt is partly true, and how much it will aid 
us in arriving at a more complete knowledge of this disease, 
and how far it will aid us in arresting its ravages, remains to 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 31 

be seen. It is well said by these gentlemen that our first duty 
is to destroy this poison if it be infectious. But as that does 
not appear to be practical, the next thing to do is to increase 
the power of the race collectively, and in the individual, to 
resist the action of the virus. I have no doubt but that 
phthisis has been propagated from one person to another in 
the same family, through the medium of the sputum, and by 
the breath when active ulceration was going on. Persons 
with an hereditary predisposition would be more liable to 
danger. In the case of man and wife I have seen phthisis 
apparently communicate where there was no predisposition. 
The following is admirable: "Where the poison has affected 
an individual, our treatment must be more directed toward 
the whole organism, as thus only we diminish his disposition 
to disease, facilitate the encysting or excretion of the poison, 
and thus prevent auto-infection die novo, to which the patient, 
even with a solitary tuberculous focus, is exposed." 

Hereditary transmission is generally believed to be by far 
the most prolific cause of phthisis ; it is not in conformation 
alone but in diathesis or hereditary cachexia that it propa- 
gates, or as just stated by infection. There is no doubt but 
that nature tends to perpetuate types and peculiarities; no 
doubt but that the expression of vitality, even in the germ, is 
very variable. In fact, there is no doubt about the transmis- 
sion of disease from parent to child, by hereditary laws. This 
element of disease may come in, I believe, with immediate 
ancestors, or it may be propagated from generation to genera- 
tion ; rheumatism, syphilis and tubercle are instances. I must 
affirm my belief that tubercle may come in accidentally, and 
afterward become a permanent cachexia, handed from genera- 
tion to generation, unless eradicated by potential measures. 
To do this, it must carry the power of modifying cell-life. 
This morbific force being engrafted into the cell-nuclei is a 
degrading energy and a propagating energy, from the parent 
cells, out of which morphological movements begin. I do not 
see any objection to naming this unknown morbific force, 
tubercle-virus, as Professor Rindfleisch would have us. 

But is that a bar to the theory, that the poison may be gen- 



32 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

erated by some process of transformation which is set up re- 
cently, and may be produced at any time, conditions favoring, 
independent of a virus carried in an ancestor, and by the 
whole family of man in a state of quasi habituation? In other 
words, if tubercle-virus may not be of spontaneous generation? 
It is doubtful indeed, if the morbific force be identical in all 
cases of phthisis pulmonalis. And yet it may be, as what 
seems exceptional may be undergoing such modifications as 
incidental influences are responsible for. 

A bovine phthisis pulmonalis is believed to be distinct from 
phthisis originating primarily from human sources. It has 
many close resemblances in its workings, and only for its 
rapidity and complications could hardly have any histological 
difference. The tubercular transformation is the same. The 
course of acute miliary tuberculosis and the course of bovine 
tuberculosis are quite as much alike as the course of acute 
tuberculosis and the course of chronic tuberculosis or caseous 
exudation. It may be as true to say that they belong to a 
family, as that they are identical. 

The spontaneous generation of infectious diseases seems to be 
pretty well settled. Scarlatina, diphtheria, cholera and other 
contagious and infectious diseases, are supposed to be generated 
from chemical changes of excreta and transformations occur- 
ring in connection with degrading molecular movements. 
Why may not tubercle-virus originate in a similar way? 
Plastic exudations follow in the course of the development of 
some of these diseases. If the virus of any of these diseases is 
thoroughly eliminated, it is not transmitted ; if it becomes a 
constitutional taint, it is transmitted by cell degradation. 



CHAPTER IV. 
TUBERCULAR TRANSFORMATIONS. 

The earliest tendency of tubercle seems to be to undergo 
fatty transformation, in which condition it becomes easily 
absorbed ; caseous degeneration is probably only at a little re- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. S3 

move from fatty degeneration ; perhaps as much a product of 
an imperfect effort of nature to fatty transformation, as any- 
thing. The structure of tubercle is modified by the time it 
has been deposited ; it varies in consistence from soft to hard. 
Soft, cheesy tubercle, studied with the microscope by mixing a 
little with water and breaking it down, presents to the eye a 
number of irregular bodies with numerous molecules. To 
these molecules pathologists have given the name of tubercle 
corpuscles ; they are of a rounded, irregular form, and meas- 
ure from the yoVo" to 40V0 °f an inch. They are distinct in 
outlines and with a very high magnifying power are seen to 
have in their walls smaller bodies which are called granules. 
Albumen, fat and minerals seem to be constituents of tubercle, 
albumen chiefly at first. The softer the tubercle, the more 
readily detected the granules, and the more abundant they 
seem to be. In hard tubercle the granules are very indistinct; 
again, the more plastic and fluent the tubercular substance, 
the greater the proportion of corpuscular or molecular ele- 
ment ; and, again, the more chronic and cretaceous the tuber- 
cular elements, the more are they transformed into gritty par- 
ticles, which chemistry shows to be earthy salts. Cretaceous 
or hardened tubercle varies very considerably in size and 
shape. 

Tubercle, as an unchanged exudation matter, is acted upon 
by acetic acid to a small degree; the corpuscles are dissolved 
by ammonia and liquor of potassa, but are not affected by 
ether or alcohol to any noticeable extent. 

By chemical analysis, tubercle is proven, then, to consist of 
animal matter mixed with certain earthy salts, and the relative 
proportion of these constituents varies in different specimens 
of tubercle; the animal matter being more abundant in newly 
deposited tubercle, and the earthy matter the more abundant 
in chronic tubercular deposit. Analysis further shows, that 
the animal matter is chiefly albumen with a trace of fibrin, to 
which is added fat in still smaller quantities; but that the fatty 
element increases more and more as the process of disintegra- 
tion goes on, separating, of course, from the earthy elements, 
which also increase as the transformation progresses. Of the 



34 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

earthy constituents, it is proved that the salts found are com- 
posed chiefly of the insoluble phosphate and carbonate of 
lime, mixed with a small proportion of the soluble salts of 
soda. The difference, then, between tubercle and other albu- 
minous compounds is very slight, so far as science is j^et able 
to detect. Structurally and chemically, tubercle must be re- 
garded as a product resulting from the working of vital pro- 
cesses upon a plane where there is a constant tendency to fatty 
and mineral transformations of albuminous matter. 

It will be remembered that the phosphates and carbonates 
of lime and soda, are remedies which have thus far gained 
the highest reputation in the treatment of pulmonary tubercu- 
losis with the dominant school, and that these have been sup- 
plemented with cod-liver oil. Dr. Samuel Swan formulates a 
principle asserting that the potentized preparations of an agent 
are able to arrest the degradation or transformation of the same 
matter moving upon a lower plane. What remedies have done 
thus far in the treatment of consumption, has been largely with 
matter which is found in tubercle when undergoing transform- 
ation. Shall we gain anything by the use of highly potentized 
matter of the same sort, is the question? Another question, 
arises with us, based upon clinical experience. Sulphur in 
the higher potencies has proved more satisfactory in its results 
with some than any other agent; that is, it has served in the 
largest number of cases. Has such service been done on an 
eliminating basis? Sulphur is known to be the most univer- 
sally eliminating agent of the materia medica. The facts may 
be tentative to some generalization of very great importance ; 
and yet, we do not expect to be able to do away with the most 
thorough individualizing of our cases, and the close work of 
differentiation as relates to remedies, if we are to succeeed in 
practice. 

To what extent this knowledge will be made scientific data, 
to help in the solution of proper therapeutical measures to ar- 
rest the mortality of this terrible disease, remains to be seen. 

That the salts, which constitute a part of the tuberculous 
matter, and which increase relatively in the transformation 
going forward where soft tubercle is changed to hard or crea- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 35 

taceous tubercle, should be the agents used most successfully 
in the cure of the tubercular destruction, is a fact of much 
significance. Does it assist in converting the soft tubercle 
into the creataceous, might be asked? that would tend to ame- 
lioration certainly. Do these agents give to nutrition correlat- 
ing energy toward higher transformation? With these facts 
before us, we can hardly say they are of no value. It is not 
as clear that we know how to apply these agents to the best 
purpose. Query: Is it not just possible that it is only some of 
the liberated molecules even, in the more crude preparations, 
which are freed from the cohesive force of crystallization, and 
acting as a nascent force, which is the true causative element 
of arrest in degradation ? Most transformations work in the 
molecules ; perhaps all. Physical science asserts that the cor- 
relating energy is exerted in the nascent state, while molecules 
are passing from one plane to another. Is there not then a 
scientific reason for using attenuations carried to the separa- 
tion of the individual molecules; thereby bringing the mole- 
cules into a condition to enter into new transformation? and 
in passing into such a change, no doubt these molecules or 
atoms would carry other atoms with them in a sort of catalytic 
action or distribution of correlating force. The attenuations 
are eminently worthy of trial. 

Chemistry, it is presumed, has not yet made the ultimate 
analysis of tubercle. Sulphur, and other minerals, no doubt, 
will be found on a more complete analysis. Indeed it is pre- 
sumable, that Sulphur is present in all albuminous products; 
in the muscles, where fibrin is most abundant, it certainly 
exists. It is one of the constituents of albumen. Exactly what 
part it plays in the organic economies I am not able to say. 
We shall have occasion to report some clinical experiences 
with this agent in phthisis pulmonalis further along. Patho- 
logists have classified tubercle: First, into miliary, where the 
tubercle is of the size of a millet-seed, and is scattered exten- 
sively through the tissue which is its seat; second, into infil- 
trated, where the tubercular deposit occurs in diffuse masses, 
such masses involving often the chief part of an organ or mem- 
brane; third, into nodular or encysted, where the tubercle is 



36 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

found in isolated, rounded bodies, from the size of a pea to a 
hazel nut; and, lastly, they make the variety called the creta- 
ceous or calcareous tubercle, which is the result of an absorp- 
tion of animal matters from the primary exudation. 

These divisions are more or less arbitrary, of course, and 
not infrequently several of the varieties are found in a single 
autopsy. Probably tubercular matter is essentially alike, the 
difference in appearance being accidental ; for miliary tubercle 
commonly is soft and can be crushed beneath the fingers, and 
is of yellow color; as is the caseous; more rarely it is found as 
a minute granule, and is semi-transparent or grayish, and hard 
to the touch. Possibly, it may now have undergone the calca- 
reous transformation retaining its millet-seed form. The miliary 
tubercle, however, varies from what is called caseous exuda- 
tion by being sprinkled throughout the lung, while the case- 
ous exudation is usually confined to the apices. And yet, many 
assert that miliary tubercle is very commonly associated with 
the caseous exudation, the school of Bennett affirming, and the 
school of Virchow denying, as a rule. But this is agreed, that 
the diffuse tubercle is miliary. Then, again, it is affirmed that 
infiltrated tubercle is often but an agglomeration of miliary 
tubercle. Miliary and infiltrated tubercle are certainly found 
in all shades of consistency, from the soft and diffluent to the 
calcareous. It looks very much as if all forms of tubercle run 
into one another. The soft certainly runs into the hard, and 
all varieties we have named are found in the same lung. The 
caseous and miliary exudations follow the same order in trans- 
formation. In both varieties the miliary tubercle and the 
cheesy exudation will be recent deposit, while the encysted 
and cretaceous will be old deposit. 

APPEARANCE OF THE LUNGS AS THE TUBERCU- 
LAR DISINTEGRATION GOES ON. 

The softening of tubercle commences at the center of the 
tubercle-corpuscles, which become turbid, yellowish, cheesy or 
opaque, and finally soften down into a purulent matter. 

A group of tubercles soften and break down in many places, 
corresponding to the number of corpuscles of which the group 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 61 

is composed. As some groups will be more advanced in the 
softening process, we shall find small primitive ulcers of a 
tubercular character, and these may soon open into one another, 
forming a common cavity as the intervening mass melts down 
in the softening process. It is important to the management 
of phthisis to understand how these tubercular ulcers enlarge 
and continue their ravages in the lungs. Whenever the soften- 
ing process has advanced to the breaking down stage, the sur- 
rounding tissue takes on that degree of irritation or inflam- 
mation which results in the sowing of a new crop of tubercles, 
abundant or less abundant, according to the intensity of the 
constitutional disease or dyscrasia. 

These again break away and carry down the structures in 
which they are deposited with a rapidity corresponding to the 
intensity of the constitutional affection ; and so the destruction 
goes on. If this process is so rapid as to exhaust the reactive 
powers of the constitution quickly, the ulcer will be found to 
have extended itself unequally in various directions, forming 
an irregular and apparently lacerated cavity with its walls 
loaded with softened tubercles. The internal surface of this 
cavity will present a gnawed appearance, without exhibiting 
evidences of a lining membrane as in the more chronic pro- 
cess of disintegration. 

On the other hand the walls will be loaded with pus globules 
and the thin border of parenchymatous structure will be of a 
dirty brownish discoloration and present a condition known 
as canification. More often softening proceeds from several 
points simultaneously, two or more cavities forming in near 
proximity, which sooner or later open into each other; we even 
find a number of cavities frequently communicating with each 
other by sinuses or fistulous passages running in direct, or per- 
haps tortuous courses, making the invaded lung look as if 
scooped out into a multi-sacular cavern. 

Bridges of parenchymatous structure will traverse these ab- 
scesses in various directions, and shreds of tissue will be seen 
hanging into the cavity. As the apices of the lungs are the 
seat of most extensive tubercular deposit, here we shall find 
the largest cavities as a rule. It is of interest to note how the 



38 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

bronchi and blood-vessels are affected by this destructive pro- 
cess as well as the pleura. 

In cutting into a cavity and dissecting out the bronchial 
tubes we shall find that the smaller or capillary bronchi have 
undergone the same degeneration as the parenchymatous por- 
tions of the lung, that their walls are filled with tubercles, and 
also that the mucous membrane is implicated. Reaching the 
larger tubes by extension of the lesion, they are perforated 
and communication is established with the abscess or cavity. 
Sometimes several bronchi are found opening into a cavity of 
large size. The blood-vessels, which usually run in an oppo- 
site direction, are obliterated as a rule, and are seen travers- 
ing the walls of the cavity as ligamentous stripes. The arteries 
are of such tissue formation that they more often withstand 
ulceration, after the surrounding tissue has broken down. Still 
it does happen much too frequently that the arterial walls are 
thinned, and losing support, they give way, and dangerous 
haemoptysis follows. 

More commonly a slower process of disintegration is set up, 
and the inflammatory action, which begins in the parenchyma 
adjacent to the softening tubercle, and perhaps in lately formed 
tubercle, throws out an albuminous grayish-white and viscid 
exudation. 

This is regarded by eminent observers to be a curative pro- 
cess on the part of nature, as it tends to close up the air-cells 
and produce atrophy by compression. While this process is 
going on, the walls of the cavity grow more even and regular, 
and often become covered with a thin, grayish lining mem- 
brane. 

Laennic regarded this exudation similar to that thrown out 
by cut surfaces or ulcerated surfaces in the healing process. 
The parenchyma forming the walls of cavities also become 
atrophied by the continuance of this process, all of which 
tends to curative action and limitation of the ravages of a 
phthisis. 

Natuie's effort here is too often unavailing, it is true, but it 
remains to be seen to what extent we can aid this effort of 
limitation and arrest of degradation of tissue. The pleura is 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 39 

often involved by abscesses reaching to the outer walls. Some- 
times this is from softening of tubercles sown in deep-seated 
structure and gradually working itself outward; but more of- 
ten from softening of tubercles sown in the neighborhood of 
the pleura. 

When the abscess extends sufficiently to come in contact 
with the pleura, we are apt to have that soften also and be- 
come lacerated. Through this lesion escapes purulent matter 
and air, giving us a severe pleuris}^ and pneumothorax, which 
usually terminates in speedy death. Fortunately, more fre- 
quently, the pleura has taken on such a degree of inflamma- 
tion in consequence of adjacent morbic action, that we have 
sufficiently firm adhesions to secure resistance to the disinte- 
grating process at this point; the callous, cellulo- fibrous or fib- 
ro-cartilaginous pseudo-membranes which are the product of 
this inflammation, being the barriers of resistance. 

These callous walls, however, do not always resist the de- 
structive process. These adhesions, as we would suppose, are 
more often in the region of the apices where tubercle is most 
abundantly, as well as most frequently found. 

When we have interstitial tubercular deposit, conjoined 
with tubercular infiltration, we have rapid breaking down of 
structure, causing what is popularly known as "galloping 
consumption." 

In this variety we are more apt to have the pleura involved, 
both, because of the rapidity of action, and because infiltrated 
tubercle occurs for the most part in the apices, and is more 
superficially seated. The appearance of the lung in addition 
to what has been said, cannot be better described than by quot- 
ing from "Pathological Anatomy," Part, I, by Rokitanski, 
pages 138, 139 and 140: 

" In the upper third of the superior lobes we generally find 
a large cavern, surrounded inferiorly by several of a smaller 
size, some of which communicate with the former; between 
these we find yellow tubercles which are on the point of soft- 
ening; a little lower down, gray tubercles, just becoming 
opaque and discolored; in the lower portions of the upper, 
and in the inferior lobes, a proportionately far smaller number 
of gray, crude tubercular granulations." 



40 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

The pulmonary parenchyma between the tubercles is found 
in various conditions, according to the stage of the consump- 
tion. 

It is found normal, but more generally in a state of slight vi- 
carious emphysema of its superficial parts, with hyperemia and 
oedema of its deeper seated parts. But it is more important to 
notice the atrophy of the parenchyma, induced in part by the 
interstitial inflammation, partly by the obliteration of the 
bronchi and air-cells, from the pressure exerted upon them by 
the agglomerated tubercles, and in part by the obstruction of 
the bronchi by the blenorrhoic mucous secretion. On the 
other hand, croupous pneumonia may have attacked the 
greater part of the parenchyma which is free from tubercles; 
it appears partly as brownish-red hepatization, partly as gray- 
ish-red, which are quickly converted into yellow tubercular 
infiltration, and break down into abscesses in various places. 
At other times, the pneumonia is followed by an exudation of 
the gelatino-glutinous product already described. In the best 
marked cases of this kind, the lungs are very voluminous, 
and are coated with a grayish-yellow, generally thin, pleuritic 
exudation, through which and the pulmonary pleura, we can 
see superficial tubercular infiltrations, surrounded by emphy- 
sematous patches. 

In the larynx we find tuberculous ulcers in various num- 
bers and of different sizes; also aphthous erosions upon the 
.tracheal, and at times upon the pharyngeal mucous membrane. 

The mucous membrane of the bronchi which go to the ab- 
scesses is in a state of infiltration to some distance, and the 
tubes are filled with tuberculous matter; besides this, they are 
always in a state of catarrh, with reddening and softening of 
their mucous membrane, which secretes a muco-purulent mat- 
ter, forming by far the greater proportion of the sputa which 
are expectorated in the course of consumption. The bronchial 
glands are enlarged and tuberculous in various degrees. 

Externally upon the lungs we find pleurisies of various ex- 
tents, and, with the most different exudations, their organiza- 
tions and consequences. They occasion, at times, those very 
acute pains in the chest, which so frequently annoy phthisical 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 41 

patients. Except when they arise from superficial pneumonia, 
they are generally developed during the softening down of 
tubercles and the formation of the abscesses, and are compli- 
cated with inflammatory reaction in the adjacent interstitial 
cellular tissue. Among these the pleurisies around the apices 
of the lungs and the body of the upper lobes are remarkable 
for the constancy of their occurrence ; they correspond to the 
favorite seat of tubercles, and deposit an exudation, which 
either becomes organized into fibro-cellular bands, or into 
thick, compact, fibrous swathes, which cover the upper lobes 
from their apices downwards in the form of a cap; they are 
thickest superiorly and gradually grow thinner from thence 
downward; they bring about an intimate adhesion of the 
lungs to the costal walls, and thus afford an effectual protec- 
tion against perforation of the pleura by large abscesses." 



CHAPTER V. 
PHYSICAL DIAGNOSIS. 



Accurate diagnosis is important to the success of treatment 
in our cases of phthisis, as well as in other grave lesions of the 
body; diagnosis in advance of tubercular exudation if possi- 
ble, but at the inception of exudation, at all events. 

In acute miliary tuberculosis there may be much difficulty 
in applying percussion to advantage, as the resonance is not so 
much diminished as to be easily detected, condensation not 
being sufficiently pronounced. The respirations, however, are 
likely to be increased, the dyspnoea more marked, and the 
more on going up-stairs and from rapid walking. Then again 
we may look for the prolonged expiration which occurs from 
pulmonary obstruction. Guttman says: "The thoracic reson- 
ance may be perfectly normal during the first stages of phthi- 
sis," and that it suffers but slight modification when patches 
of healthy lung tissues are still found between the condensed 
portions. This is good authority, yet we do not believe tuber- 
cular deposit can go on to any considerable extent without 
4 



42 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

diminishing the resonant capacity of the lungs. In addition 
to obtaining the facts upon points already named, we may use 
the spirometer and thus determine the vital capacity; if there 
should be found a loss of forty cubic inches in lung capacity, 
it would denote condensation of a cubic inch of the lungs and 
suggest tubercle. Dr. Radclyffe Hall, of London, says: "To 
know how much air a man does habitually consume is second 
in importance to no other fact in determining his condition. 
It is a symptom to be noticed and measured in every case of 
disease, most especially diseases of the lungs; the great and 
most satisfactory deduction being, that if on a proper examina- 
tion, the lungs of any given person are working freely and 
fully, one thing is demonstrably true, he or she certainly has 
nothing like consumption. On the other hand, just in propor- 
tion as a person is habitually breathing less air than he ought, 
in such proportion is he falling fast and surely into a fatal 
disease." This tendency to consumption can usually be dis- 
covered years in advance of actual occurrence of the disease. 
In the early stages of consumption the spirometer is of much 
more value, it seems to me, than auscultation or percussion. 

Jerking Respirations. — The jerking respiration is another 
symptom of condensation. This term is used to describe a 
vesicular inspiration, which divides into two or more parts;' 
should the air-cells in the apices, for instance, become partially 
blocked by infiltration of a caseous degeneration, and the bron- 
chii at the same time be reduced in size by tumefaction of the 
mucous membrane, the lung tissue would be less accessible to 
air, and the air would reach the cells later than the freely 
permeable lung would expand, — this gives a jerking or inter- 
rupted way of breathing. More often, perhaps, it may point 
to incipient catarrh of the apices, but this is a precursor of 
cheesy condensation. Says Guttman : " Experience shows that 
catarrh of the apices is seldom primary but usually secondary, 
indicating the beginning of caseous condensation in these 
parts." 

The Rough Murmur. — The harsh or rough vesicular mur- 
mur, if heard in one or both apices and remaining perma- 
nently, furnishes good grounds for suspicion of a phthisical 
attack. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 46 

Prolonged Expiration. — Prolonged expiration, as we have 
said, is one of the earliest signs of the commencement of tuber- 
cular deposit or cheesy degeneration. It is often attended with 
rales, either dry or moist, which point to the same inference ; 
it always points at least to a hindrance to the free escape of 
the air. A point to be made is that in cheesy condensation 
the murmur is more localized than if caused by other obstruc- 
tions than tubercle. 

Force in Expiration. — In the healthy person the force of 
expiration exceeds that of inspiration; upon this fact diseases 
of the lungs have been divided into two pneumatrometric 
types. When the positive expiratory pressure becomes less 
than the negative inspiratory force, we may be sure of diminu- 
tion of elasticity in the lung-tissue, as in bronchitis, nervous asth- 
ma and pulmonary emphysema. When the inspiratory power 
is lessened, it is clear that there is a resistance to expansion of 
the lung-tissue, and this may come of stenosis of the trachea and 
larynx ; from pneumonia, pleurisy and tubercle. In tubercle 
the inspiratory power is lessened when the disease is of very 
slight extent. In diagnosis we will easily be able to say 
whether this diminution of inspiratory power comes of stenosis 
of the larynx, from pleurisy, and very likely if of pneumonia, 
especially if we take the entire history of the case into account. 
Diminished force in inspiration then becomes a valuable 
symptom in the diagnosis of tuberculosis of the lungs, espe- 
cially in the early stage. A careful examination covering 
these points will very definitely enable one to decide whether 
they have an incipient phthisis in progress of development, 
certainly if family and private history and temperament be 
carefully studied. This early period of the disease is most im- 
portant to be made out, as at this stage a large per cent, of 
phthisical cases are curable, while if left to the course of nature, 
at no very remote period, a large majority of the cases are not 
found amenable to remedies. The latter stages of the disease, 
of course, are more easily determined by physical diagnosis, 
and this should be carefully applied. 

Configuration. — Abnormal changes in the thoracic walls 
are important to note in all examinations for thoracic diseases. 



44 PHTHISIS PULMONALIS : TUBEKCULAB, PHTHISIS. 

A typical chest is noted for the symmetry of the two sides ver- 
tically and in each circle from the sternum to the spine. The 
supra and infra-clavicular spaces should round up nearly level 
with the clavicles, with a gradual swell of the chest to the nipples 
and then a gradual return curve, leaving the walls most promi- 
nent at the fifth rib; the vertebral column and sternum should 
be vertical or nearly so, and the scapula placed so as to keep 
the generally swelling curves complete, w T ith a symmetrical 
depression in the line of the vertebral column, from which the 
spinous processes stand prominent. From a typical chest dif- 
ferent deviations can be studied; there are a few deviations 
which are physiological and of no importance as bearing upon 
a morbid condition of the lungs — undue prominence of the 
clavicles in the line of the costo-sternal articulations, and pos- 
sibly of the sternum itself, belong to this class. Depressions 
may also exist and more often in the sternum than elsewhere, 
especially the inferior portion, and is often the result of the 
last of the shoemaker. 

Changes which indicate pathological conditions are what 
we wish to study ; of these, expansion and contraction are most 
important to note. Expansion may be upon one side or upon 
both sides; this may be brought about by hepatization of the 
lung, if complete, but more often it comes of morbid growths, 
or the presence of air, serum, or purulent matters within the 
pleural sac. Pleuritic effusions not unfrequently occupy so 
large a space in the thoracic cavity as to cause very consider- 
able enlargement. The first indication of enlargement in 
these cases is that of flattening of the intercostal spaces, as the 
muscles become inactive from the limited range of movement 
of the lung. Both the vertical and transverse diameters are 
increased when large accumulations have taken place ; if the 
morbid product be a fluid, it will occupy the lower portion of 
the thoracic spaces, and change as the patient changes position 
from the sitting to the recumbent posture, or from side to 
side; this makes pleuritic infiltrations easy to determine; 
morbid growths or misplaced viscera have no such mobility. 
Pneumothorax, or air in the pleural sac, presents the same 
external conformation of the chest as does pleuritic effusion, 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 45 

but it is usually more sudden, often coming from a fractured 
rib, a stab, or a gunshot wound, more rarely from the rupture 
of some pulmonary cavity, which communicates with one of 
the larger bronchi. Then the resonance of air upon percus- 
sion is quite unlike the dulness of serum, nor does air gravi- 
tate as does water. Bulging of the lower portions of the thorax 
when upon the right side, if not of pleuritic effusions, is usu- 
ally from morbid enlargements of the liver, such as hydatids, 
and when upon the left side more commonly from enlarge- 
ment of the spleen. 

In pneumonia we have usually an acute attack with highly 
inflammatory symptoms; we also have as a rule the lower 
lobes of the lungs as the seat of the attack, especially does this 
hold good of the right lung; yet we may have the upper lobe 
or the middle lobe, or even both lower lobes as the seat of 
attack. When the entire lower lobe is affected we have reso- 
nance diminished as high as to the middle of the scapula 
posteriorly; if the middle lobe be the seat of attack dulness is 
most clearly detected between the fourth and fifth ribs. In 
pneumonia of the apices the dulness extends down to the 
fourth or fifth rib ; if the whole lobe is hepatized we are able 
to trace externally the outlines, as* the lobe so consolidated 
increases considerably in bulk, and the region occupied be- 
comes expanded. There may be isolated patches with pneu- 
monic infiltration, and the percussion note not be altered, so 
resonant is all the surrounding tissue. Pneumonia in the 
middle of the lung presents similar difficulties in the way of 
percussion. 

Hepatization presents us a condition of complete consolida- 
tion and a corresponding dulness ; other varieties of pulmo- 
nary condensation will have a measure of dulness modified 
by locality and density of the lung. Cheesy exudation and 
chronic insterstitial pneumonia, involving usually the apices 
of the lungs and known often by the collective, term phthisis, 
give us the most marked examples of condensation outside of 
hepatization of the lungs. In the disease known as cheesy 
pneumonia in Germany but as caseous exudation in England 
and America, condensation of the lung may occur in both 



46 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

upper lobes, but seldom at the same time with equal severity. 
If the attack is uni-lateral it is usually upon the right side. 
Dulness in such attacks is most marked in the supra-clavicular 
regions and on the clavicles themselves. Possibly the dulness 
is most marked in the supra-spinous regions fixing the exu- 
dation in the posterior apices. If the condensation extends 
downward the dulness extends with it, and this is frequently 
the case too as low as the fourth rib. Exceptionally the per- 
cussion sound may be tympanitic in the supra and infra- 
clavicular space in a case of caseous infiltration, but the so and 
will always be muffled and tone does not change when the 
mouth is open. 

Depressions upon the Surface. — A group of pathological 
symptoms more definitely related to our subject, is where we 
have circumscribed depressions of the surface; they follow 
shrinking of the lung from any cause which may occasion a 
collaj)se, but by far the most common cause is caseous conden- 
sation of the lungs. The reason of the depression is clear, for 
when the lung fails to occupy as much space by reason of con- 
densation, the walls become depressed from the force of atmos- 
pheric pressure acting upon the outer walls. The upper an- 
terior portions of the chest in the supra and infra-clavicular 
regions, are the points where such depressions are most fre- 
quently found. There is likely to be little depression on the 
lower posterior portion of the chest, even if the lung tissue 
has shrunken away, because of the large and powerful dorsal 
muscles. Tubercle is not nearly as frequently found in the 
lower lobes of the lungs, however, and depressions here are 
more likely to be from other causes. In chronic interstitial 
pneumonia the pulmonary contraction is often very marked, 
especially if the subject be a child. There is a kind of chest 
malformation which depends upon structural development, 
and has its origin, no doubt, in faults of nutrition, as has 
rachitis and kindred affections. 

It will be recognized as the consumptive chest, long, thin 
and narrow, with wing-like projection of the shoulder-blades, 
the scapular end of the clavicles prominent; associated with 
this chest we have the elongated neck, long extremities, deli- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 47 

cate skin and possibly distorted joints of the fingers. A con- 
formation favoring condensation because of the cramped spaces 
which prevent the free action of the lungs. Presumably the 
low grade of vitality which such a condition indicates is the 
first and the greater cause after all. 

Thoracic Measurements. — It is quite well to take the 
measurements of the chest when estimating the condition of 
soundness or unsoundness, and yet to a practiced eye very 
slight variations in the form and capacity of the chest will be 
pretty accurately judged of, simply by inspection, some varia- 
tions are even better detected by the eye. The tape and calli- 
pers have commonly been resorted to for obtaining thoracic 
mensuration. It should be remembered that the right lung is 
usually the larger. The circumference taken at the point of 
the nipple and lower angles of the scapula, when the arms are 
raised and extended, is a fraction less than 32.3 inches in the 
average man at the end of an ordinary expiration, and not far 
from 34 inches after a deep inspiration. In old age it dimin- 
ishes somewhat. The measurement at the ensiform cartilage 
also shows that the lower respiration increases while the up- 
per diminishes as age advances. The above are Trolich's num- 
bers. The diameter of the chest taken from the clavicle to the 
base of the chest is called the long diameter ; diameters taken 
from any point on the sides to a corresponding point upon the 
other side, and from a point anteriorly to a corresponding point 
posteriorly, are called respectively transverse diameters and 
antero-posterior or sterno-vertebral diameters. The long di- 
ameter is very variable. The sterno-vertebral varies from a 
little less than 6.3 inches superiorly to 7.5, or nearly, inferiorly. 
The transverse diameters run from 9.8 to 10.2, and a little more. 
Women give smaller diameters as their type of organic life is 
more diminutive. 

Respiratory Movements. — The lung movement corre- 
sponds to the movements of the thoracic walls ; such move- 
ment takes place in two directions, from above downward and 
from behind forward, the apex being the fixed point of the 
first, and the latter having a fixed point at the posterior cen- 
ter of the lung probably. Any considerable inequality of 



48 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

movement is easily detected by the eye and points to some 
obstruction in the lung tissue. Such differences are more 
easily detected with the person standing in profile; the move- 
ments of the shoulder-blades also are quite diagnostic ; should 
the obstruction be situated in the upper lobe of one or both 
lungs, the more common point of tubercular deposit, the lim- 
itation of the chest movements is seen to be in the upper 
thoracic region ; if only one side is affected, on the affected 
side of course; if both lungs, the embarrassment extends 
across over both sides; but in this event it would be more 
difficult to judge of it because of having no sound lung by 
which to compare the movements. Again in cases where we 
have extensive softening of tubercle giving a large cavity, it 
has been noticed that at the time of inspiration there is marked 
depression in the walls at that place and at the time of expira- 
tion there is seen a bulging prominence. This is accounted 
for on the theory that the lung being condensed by tubercle it 
is inexpansible and does not follow the chest walls when raised 
by inspiration. We have also depressions from vesicular em- 
physema and croupal strictures, but these are more often seen 
at the supra- clavicular regions above the sternal notch or in 
the lower lateral intercostal spaces in the region of the epigas- 
trium. A very low respiration again is often diagnostic of tu- 
bercle. When an impediment to the passage of air into the 
upper portion of the lobes of the lungs exists, the lower lobes 
act more vigorously, the diaphragm contracts more powerfully, 
and the chest inferiorly swells and broadens in an exaggerated 
manner. Carefully studied these various peculiarities help make 
out a correct diagnosis. When studying the respiratory move- 
ments we should remember that in women the thoracic move- 
ments tend to decrease from above downwards, and also that 
in young persons the upper portion frequently moves more 
than the lower portion, a condition reversed in old age. 

Frequency of Respiration. — From sixteen to twenty respi- 
rations may be set down as about the average number per 
minute in the healthy adult male, rather less than more; some 
allow one respiration to four pulse beats — in sleep this is per- 
haps very nearly correct. Many causes operate to increase the 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 49 

frequency of respiration; among the more marked we may- 
mention impoverishment of the blood, and diseases of the heart, 
which prevent a proper return of the blood, stenosis from 
croupal exudations, pleuritic pains which limit expansion of 
the lungs, and obstruction from pneumonic and tubercular 
infiltrations. The value of this frequency of respiration is of 
most importance in judging of the extent of the infiltration. 
Shortness of breath should be looked upon with suspicion 
when not adequately accounted for from other causes. It is 
not always increased, however, even when considerable pro- 
gress in a tubercular disease has been made. The volume of 
blood is known to determine largely the character of respiration. 
When by the progress of a chronic disease, like tubercle, the 
system has become impoverished of blood, the lungs, even 
though greatly crippled, will be able to perform a necessary 
function, to so small a volume of blood, and hence little acceler- 
ation of breathing will be present. 



CHAPTER VI. 
THORACIC PERCUSSION. 



The practice of percussing the thoracic walls in the study of 
tubercular affections of the lungs has become a part of every 
thorough examination, and its importance is not likely to be 
overestimated. Two methods are used, the mediate and im- 
mediate ; the immediate, which was the method of Auenbrug- 
ger, is performed by striking the walls with the finger-tips 
directly ; the mediate is where some substance intervenes and 
is struck upon; this may be the finger or a pleximeter, and 
we may strike the pleximeter with the finger or a hammer. 
The important fact is to familiarize the ear to the normal 
sounds of the chest and to learn to detect any variation, espe- 
cially dulness, if we are looking for tubercular exudation. We 
prefer the index or second finger of the left hand, firmly ap- 
plied to the walls, to any other media ; this can be better fitted 
to the uneven surfaces than the pleximeter, and the blow is 



50 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

given with the middle finger of the right hand to bring out 
the chest sounds. Certainly if we wish to define sharply the 
bounds of sound and unsound structure, this is the most feasi- 
ble way. Others prefer the glass or ivory pleximeter and 
strike with the finger or hammer, as they may choose. Flint 
has invented a good percussor and pleximeter, and Winterich 
has also invented an admirable percussion hammer which is 
manufactured by Tiemann. Those who are curious in these 
matters will consult some handbook on physical diagnosis. 
By any of these methods a nearly absolutely accurate result 
may be obtained, provided the physician has attained to skill 
in the performance of his work, if we except those cases here- 
tofore discussed. It may be said of a skilful digital manipu- 
lator that he will use the hammer almost equally as well, 
while one who learns by the hammer does not prove to have 
gained much in the way of qualification for a good digital ex- 
aminer. A very important point is that one possess a very 
sensitive ear, and this needs to be well trained to the different 
vibrations in sound; quality of sound and volume of sound 
are to be very carefully studied. The stroke is also of im- 
portance ; if there be overlying tissue of considerable thickness, 
as in the mammary and supra-scapular regions, and some 
places covered with the larger muscles, it will require a stroke 
carrying much more force, in order to bring out from the 
parenchymatous structure the representative sounds, than on 
places covered with but little material to embarrass sound. 
Again, we may want to bring out sounds from structure con- 
taining air underlying other internal organs, especially would 
this require a forcible impulse upon the walls, contrariwise, it 
will be necessary to give a gentle blow where the walls are 
thin and the structure being explored is superficial. In fol- 
lowing down also upon the border of the liver, a gentle stroke 
gives the boundary between lung-tissue and hepatic tissue 
much better than the forcible impulse. 

RESONANCE. 

The principal factor in the production of thoracic sounds, 
is the vibration of air contained in the pulmonary air-cells; 
to this is added the vibration of the chest-walls and the ten- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 51 

sion of the parenchyma of the lungs; this is proven from the 
fact that as the air vesicles become occluded, dulness of sound 
increases as in tubercular infiltration and hepatization. But 
a lung out of the thoracic cavity is not as resonant as one 
in, so we must conclude that something of resonance is ob- 
tained from the walls; and then, pathological changes modi- 
fying tension, modify resonance also. In relation to the 
quality of sound perhaps the terms clear and dull, or resonant, 
and dull, may convey what is meant as well as any, although 
attempts have been made to amplify and improve our nomen- 
clature — muffled or obscured may be added if we wish for 
nicer distinctions. When we have less than normal resonance 
in a percussion sound, we may expect one of two conditions, 
either that the air vesicles are obliterated by plastic exudation, 
or that they are closed from pressure such as would follow 
from the presence of fluids in the pleural sacs or tumors within 
the thoracic spaces. Of dulness due to infiltration we need to 
study carefully that of hepatization from caseous degeneration 
and other forms of tubercle, also that of emphysema and the 
products of pleurisy. In the first stage of pneumonia, even 
though the capillaries become strangulated and over-distended 
with blood, the thoracic resonance is normal ; it is only at the 
end of the second stage when the alveoli are filled with plastic 
exudation that the intensity of sound diminishes. If the infil- 
tration goes on instead of being absorbed, and remains a per- 
manent impediment in the form of chronic induration, we 
have what is known as a hepatized lung with the dull liver 
sound. In a case of hepatization you will not only have dul- 
ness, but bronchial respiration much more marked than in 
other forms of condensation. The character of the acute attack, 
the rust-colored sputa if we have it, will help to distinguish a 
pneumonic hepatization from tubercular condensation. In 
diagnosticating as to whether dulness in the lower lobe comes 
of hepatization or vesicular emphysema, it is important to 
define accurately the boundaries of the border of the right 
lung ; for if it does not go beyond the normal limits it may be 
safely concluded that we have no emphysema. Dulness from 
effusions are distinguished from both tubercle and hepatization 
by their mobility, thus shifting the place of dulness, espe- 



52 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

cially the upper border. It is of importance when comparing 
the probabilities of tubercular condensation as against hepati- 
zation, to remember that the caseous exudation occurs far 
more frequently in the apices of the lungs than elsewhere, 
while pneumonia attacks the lower lobes, especially upon the 
right side. It is not common to have both apices attacked at 
the same time, though possibly they may be ; but it is very 
common for the disease to propagate from one apex to the 
other in tubercle. Dulness produced from caseous exudation 
into the apices, is usually most marked from percussing the 
clavicles and the infra-clavicular spaces. The tone in the 
supra-spinous regions also becomes dull if the whole of the 
apex is involved, whether the condensation be more anteriorly 
or posteriorly may be judged of by increase of dulness where 
the condensation is most marked. Infra-clavicular dulness 
follows with the progress of condensation downward in the 
superior lobe which may extend as far as the fourth rib. We 
have occasionally found the lower portion of the upper lobe 
infiltrated, while the apices appeared to be comparatively free; 
especially have we met this after imperfectly cured pneumonic 
attacks. 

Hemorrhagic infarctions caused by mitral. lesions are some- 
times met with, but they occur in the middle and lower lobes 
of the right lung usually, and the valvular sounds and history 
of case will clear up all doubts in such cases. Tumors in the 
mediastinum sometimes are met with, but they are not likely 
to be mistaken for tubercular condensation. 

Degrees of Resonance. — Degrees of resonance and dull- 
ness are much more readily made out in all places where 
sound can be properly eliminated, from the gentle tap than 
the more energetic blow. Of course in children there is less 
need of a strong blow, and if given, might possibly deceive 
from the fact that the impulse would be likely to call out reson- 
ant sounds from the abdomen ; over tubercular places where 
softening has begun, and over cavities, gentleness in our ex- 
plorations is necessary if we would avoid pain, and possibly 
hemorrhage in consequence of violent coughing which we 
may provoke. In percussing the back the patient should be 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 53 

required to fold his arms in front so as to give all possible 
space between the two scapulas, also in percussing over the 
region of the supra-clavicular fossae, the patient should look 
directly forwards and keep the head erect, so as to avoid ten- 
sion of the muscles spreading over this space, which would 
obstruct sound. Percussion should be carried on symmetrically, 
comparing one side with the other, as any difference in sound 
is best detected by this method, and work from above down- 
wards; on the right side this may be carried to the edge of the 
lung, on the left side the heart will be. encountered at the 
fourth rib. Lateral examinations can be instituted and com- 
parisons made till the fourth rib is reached, when the space 
occupied by the heart will have to be deducted. Similar ten- 
sion of muscles upon the two sides should be maintained, if 
we are to make accurate and nice comparative distinctions. 
The details well carried out often makes the difference between 
accuracy in diagnosis, and an examination of no practical 
value. 

CHARACTER OF TONES. 

Different tones following the percussion blow have been 
classed as tympanitic percussion sounds, tracheal resonance, 
amphoric resonance and the cracked-pot sounds. These have 
some significance in following out a tubercular condensation 
as it. goes through different periods of transformation. 

Tympanitic Sounds. — Any condition which favors retrac- 
tion of the lung tissue may give rise to a tympanitic percussion 
sound. Pleurisy, pneumonia, oedema and caseous condensation 
may all produce retraction ; but it is in the apices chiefly that 
this will be observed, and will be heard in the supra and 
infra-clavicular spaces. The sound will be somewhat muffled, 
and the pitch will not change on opening or shutting the 
mouth, a point which will distinguish condensation from a 
cavity here. It is owing to the tissue not being completely 
infiltrated, some of the alveoli yet filling with air, while at the 
same time the lung tissue is relaxed. The tracheal resonance 
is found almost exclusively upon the left side, and is probably 
due to the greater length of the chief bronchus on that side; 



54 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

it more often is the result of pneumonic infiltration filling 
completely the upper left lobe than anything else. The tone 
is louder on opening the mouth, and deeper on closing it. 

The Cracked-pot Sound. — The cracked-pot sound occurs 
when cavities exist in moderate size ; in thoracic fistula which 
may follow the use of the trochar; in pneumothorax from gun- 
shot wounds or stabbing, possibly in pleurisy and in pneumo- 
nia. There will be this difference if it come of either of these 
last conditions: the cracked-pot sound will not be augmented 
by opening the mouth, while in the other cases it will be very 
considerably increased. By far the most common cause of its 
production is vomicae in the upper lobes, and if a patient is 
known to be tuberculous, it may be considered diagnostic of a 
cavity. 

Amphoric Resonance. — The amphoric resonance is heard 
where large cavities exist, and where there is an accumula- 
tion of air in the pleural sac. Apart from the percussion 
stroke the sound depends for the most part upon . the size of 
the cavity, if it be from tubercular disintegration. It is in- 
creased somewhat by opening the mouth — the sound is almost 
identical with that produced by striking on the side of an 
empty cask or large india rubber ball. 



CHAPTER VII. 
AUSCULTATION. 



As in percussion there are two methods of auscultation, 
mediate and immediate; the immediate being that of apply- 
ing the ear directly to the walls of the chest, and the mediate 
where the stethoscope is employed. Applying the ear direct 
has some advantages; the sounds are more distinct, while a 
larger area can be examined at the same moment. It is neces- 
sary sometimes to go through an examination rapidly, because 
of the weakness of your patient : this method at such a time 
has great advantage. It may be more difficult to adjust the 
ear to such points as the supra-clavicular spaces, especially if 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 55 

much emaciation exist ; again if there should be hair upon 
the chest the friction occasioned by respiration might mislead, 
but the application of a little water would obviate this friction 
sound. If it were necessary to confine the exploration within 
very narrow limits, the stethoscope would have great advan- 
tages, so it is well to familiarize the ear to both methods. 
Although very satisfactory examinations are made when the 
chest remains covered with the chemise, the ear applied to 
the walls of the chest direct gives the sounds more distinct, 
and this adds to certainty; and very few after proper expla- 
nation will object. A thin handkerchief will less obstruct the 
murmurs than the chemise. As an early diagnosis of tuber- 
cle in the lungs is of more practical importance than a later 
one, and as such diagnosis is much more difficult to be made 
in the inceptive stage of tuberculosis, a thorough and com- 
plete examination is imperative. Education of the ear to 
normal and abnormal sounds becomes necessary to a good 
auscultator. If the stethoscope be used, care should be taken 
not to press too hard on the thoracic wall, as this is painful 
where there is emaciation. Sounds produced by both inspi- 
ration and expiration are to be studied. These sounds have 
been classified into : first, simple respiratory murmurs; second, 
rales occurring during respiration and produced by the pres- 
ence of fluid matter in the bronchi or parenchyma of the 
lung; third, friction sounds coming from the rubbing of 
roughened pleural surfaces upon each other; and fourthly, 
sounds arising from the cough and voice. Skoda divides the 
simple respiratory murmurs, both in the sound and diseased 
lung, into three varieties: first, the vesicular respiratory mur- 
mur; second, the bronchial respiratory murmur; and third, 
the indeterminate respiratory murmur. The first is produced 
at the instant at which the air passes into the alveoli; how 
the murmur is produced is not well understood. Skoda and 
Laennec thought it arose from the friction of air against the 
cell walls while in a state of dilatation; Niemeyer and others, 
say that it is caused by a temporary stenosis which takes 
place in the minute bronchioles. Baas regards that all respi- 
ratory murmurs are of tracheal origin, being modified by the 



56 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

resonant spaces to which the air is conducted; in the bronchi 
it is bronchial respiration; in the alveoli it is vesicular. The 
vesicular murmur over the healthy lung is most intense where 
the walls are the thinnest; hence it is louder anteriorly than 
posteriorly; most intensified at the infra-clavicular spaces; 
weakest at supra and infra-scapular regions. Wherever the 
lung tissue becomes thin the murmur also weakens, as at the 
apices and the inferior borders. The vesicular murmur is 
audible only during inspiration; this murmur has been di- 
vided into the rough murmur and the soft murmur ; the nor- 
mal murmur is soft, but any impediment to ingress of air to 
the alveoli gives a rough or harsh murmur. For instance, if 
the walls become thickened by a catarrh, the hypertrophy 
produces the harsh vesicular murmur; this rough murmur 
may be circumscribed, or it may extend to the whole lung; 
it is of diagnostic value to decide if the rough murmur be 
strictly confined within narrow limits if we would determine 
the nature and cause of our catarrh ; for if it be at the apices 
it is suggestive of caseous exudation — a primary catarrh 
rarely commences here; if of secondary origin, as has been re- 
marked, there is probably tubercle in the apices. The harsh 
sound, however, is heard over the whole lung in simple bron- 
chial catarrh, as also in secondary bronchial inflammations 
with complications. The circumscribed character is the im- 
portant diagnostic point; this, taken together with associated 
symptoms will determine the existence or non-existence of tu- 
bercle. In children under twelve years of age we have the 
harsh murmur as a normal sound, and it is called in this case 
puerile. 

Jerking Inspiration. — Another variety of the" vesicular 
murmur has obtained the name of jerking inspiration. This 
will occur if the alveoli of the apices become obstructed with 
caseous exudation, or even if the lung-tissue become infiltrated 
from any cause — the more common cause, however, being 
tubercle. The reason for the sound is that the finer bronchi 
become narrowed, either by compression or thickening of the 
walls of the bronchioles, or both. This condition does not 
admit the air as readily into the air-cells, occasioning the lung 



PHTHISIS PULMONALISI TUBERCULAR PHTHISIS. 57 

to be later in expanding — a fact which gives the interrupted 
inspiration. This will be likely to disappear after repeated 
full inspirations or after an attack of coughing, for a time, 
only to return, however, after a little. Possibly this character 
of respiration may exist from other obstructive causes of a 
temporary nature, when, of course, no serious import would 
attach to it; but if it continue for any considerable time, 
the fact is very significant as pointing to a serious invasion of 
the apices. Conjoined with this peculiar murmur, we shall 
also be likely to have prolonged expiration if tubercle exist in 
the apices. Collapse of the lung from aqueous effusions, py- 
emia or emphysema would abolish the vesicular murmur 
entire; also in extensive hepatization it would no longer be 
heard wherever such condensation existed. Occlusion of one 
of the principal bronchi by a foreign body would also so 
diminish the murmur as to well nigh make it imperceptible 
to the ear. 

The Expiratory Murmur. — This is a sound produced by 
the egress of air through the bronchial passages ; it is a sort 
of buzzing, not very well defined sound, much shorter than 
the vesicular murmur and wholly dissimilar in character. 
The abnormal expiratory murmur may be of two classes : the 
prolonged and the harsh murmur, and more often both will 
be found together. The prolonged expiration always indicates 
obstruction to freedom in the escape of air ; it attends severe 
bronchial catarrh, as such attacks thicken the mucus walls of 
the bronchi; it is even more marked in cases of diffuse bron- 
chial catarrh associated with emphysema. It is also found 
connected with condensation of the lungs, but in this case 
more localized. If limited, for instance, to one of the apices, 
it is one of the earliest indications of caseous exudation. The 
harsh expiratory murmur, also caused by obstruction, has 
about the same significance. 

Bronchial Respiratory Murmurs. — They occur in conden- 
sation of the lung tissue and in pulmonary cavities. As pneu- 
monic hepatization affords the highest degree of condensation, 
so the bronchial sound is most sonorous in this variety of con- 
densation. If the lower lobe be the seat of hepatization, this 
5 



58 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

bruit is likely to be heard from the base of the lung to the 
middle of the scapula; should the pneumonia, however, be 
circumscribed, as possibly it may be, the bronchial sound 
might not exist at all, for there must be bronchi of sufficient 
size included in the condensed portion to yield the bronchial 
sound, or it will be absent. The sound also ceases upon the 
clearing up of the hepatic infiltration. In cases of caseous 
condensation and in chronic interstitial pneumonia associated 
with dilatation of the bronchi, the bronchial respiration is 
found, but never so intense as in pulmonary hepatization, both 
for the reason that the dull spaces are more limited, and be- 
cause there is likely to be more or less of the alveoli in the 
immediate locality still admitting the air, which always dead- 
ens the murmur. The bronchial sound will occur whenever 
the lung is rendered void of air from any cause. Pleuritic 
exudations, pneumothorax, hypertrophy of the heart, etc., all 
yield the bronchial sound. Softening of tubercle and the 
opening up of cavities in the lungs, however, is the more com- 
com cause. The vomica? must be of some size, and if situated 
superficially, this favors the production of a bronchial sound. 
The size of the bronchi which opens into the cavity has much 
to do with, the intensity of the sound ; it is also increased by 
the energy of the respiration. It is not often, however, heard 
in the smaller cavities, especially if they be removed from the 
larger bronchial tubes. A modified bronchial murmur has 
been introduced into handbooks of physical diagnosis from 
Seitz. It occurs only at the time of inspiration; it is a very 
harsh murmur, such as is heard in cases of stenosis of the 
bronchi, or diffuse bronchial catarrh of long standing allied 
with emphysema. 

The sound continues for about one-third of the length of 
the inspiration, which is then followed by a metallic echo, 
rales and other bronchial murmurs; it is always associated 
with cavities, and for the most part is heard in the upper 
lobes. 

Amphoric Respiratory Sound. — This again has the metal- 
lic tone or echo; it owes its name to its resemblance to the 
sound produced by blowing into a bottle, where the air passes 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 59 

from, a narrow space into a large chamber. It may occur at 
the time of inspiration alone, at the time of expiration alone, 
or in both cases, but is generally loudest when it accompanies 
expiration. The cavities must be large in order to obtain the 
conditions necessary to its production. It occurs also in cases 
of accumulation of air in the plural sac. As the majority of 
pulmonary cavities are to be found in the upper lobes, of 
course here is where we more frequently find the murmur ; 
and as the walls are thinnest anteriorly, there the sound will 
be heard most pronounced. 

Indeterminate Respiratory Sounds. — Skoda in differentia- 
ting between the vesicular and bronchial respiratory murmurs 
found transition murmurs which could not properly be classed 
as either bronchial or vesicular, which he named indetermin- 
ate. It needs a trained ear to appreciate this kind of murmur. 
One cause of the murmur seems to be a shallow inspiration ; 
this sends the air with too little force into the air-cells to ob- 
tain the vesicular murmur, especially where coverings of the 
chest walls are thick as about the shoulders. A forcible res- 
piration will usually bring out a clear vesicular murmur. 

The causes are, first, insufficient expansion of the air-cells ; 
second, obstruction of a large bronchus or of several smaller 
bronchi where there is infiltrated lung tissue, and generally 
with it there will be abundant secretion of mucus. This oc- 
curs in cases of caseous exudation associated with a bronchial 
catarrh. Indeterminate sounds in such cases often disappear 
after coughing and clearing out the mucus obstruction. Lastly, 
all pathological murmurs become indeterminate when marked 
by loud rales. 

RALES. 

In normal respiration we have no rales, but as soon as the 
mucous membrane of the respiratory tract becomes uneven 
by thickening or hyperplasia, and the mucus glands begin 
to throw out mucus freely, we have accessory sounds added 
to the normal murmur, and these have obtained the name 
of rales. The manner in which these rales are produced is 
very variable, depending upon the peculiar pathological con- 
ditions present. They are produced in the alveoli, in the 



60 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

larger and smaller bronchi, and in cavities of the lungs. For 
the most, they are dependent upon the action of air entering 
fluids and forming bubbles which break in the bronchi or 
cavities with a crackling or explosive sound. Possibly in the 
alveoli and minute bronchioles the rales may be produced by 
air passing over the fluids at the time of contraction and ex- 
pansion. Rales are divided into two varieties, the moist and 
the dry; difference in the consistence of the secretions being 
the cause of the different sounds; the moist being caused by 
thin and wateiy secretions, and the dry by thick and more 
tenacious secretions. The moist rales are quite like to the 
breaking of soap bubbles in character of sound ; the finer rales 
are more like the sounds produced by rubbing the hair be- 
tween the fingers or the crepitating sound of salt when thrown 
upon fire. The constituent character of the fluid producing 
the rales is not usually easily made out from the rales. It 
may be judged of when determined whether the rales come 
from cavities or bronchial tubes, and the seat of the rales is 
not usually difficult to be made out. Rales are audible in all 
stages of respiration, rather more frequently perhaps in inspi- 
ration. Very commonly the fluid in which the rales are pro- 
duced is lodged in the bronchioles, and in such cases the rales 
occur at the acme of inspiration and at commencement of 
expiration. Should the secretion be so abundant as to be 
found in the larger bronchi at the same time, the rales would 
be almost continuous. We have rales in the respiratory pause, 
and they indicate cavities in the lungs. Guttman says that he 
has never heard them except in connection with large cavities. 
Rales are scanty or abundant as the case may be; their num- 
ber depends upon the amount of fluid in the alveoli, bronchi 
and cavities, as well as the proximity of the lesion to the 
thoracic walls. Persistent and abundant rales have been 
spoken of as gurgling rales; such are found more commonly 
in connection with cavities of considerable size secreting very 
copiously; possibly they may be found in connection with 
aggravated catarrhal attacks of the smaller bronchi. 

Intensity of the Rales. — Intensity corresponds to the 
energy of the respiratory act and the quantity of fluid present; 
it is also increased by the extent of tissue involved, and if it 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 61 

be near the walls it is the more readily communicated to the 
ear. The larger bronchi always give a louder rale than the 
smaller or the air-cells. If the rale come from the larger 
bronchi, it is not necessary that there should be a great amount 
of fluid to get a very decided rale, the surface being very con- 
siderable here and superficial to the ear, while in the finer 
bronchial tubes the rales, though numerous, are not easily de- 
tected without the aid of mediate or immediate auscultation. 
Though they should be very pronounced in cavities even, they 
are not as distinct to the ear as the rales from the larger bronchi } 
for the obvious reason that they are farther removed from the 
ear, and come to the ear through walls which intercept the 
sound. Then again if the stethoscope be used, the nearer the 
cavity to the stethoscope the more intense the sound, and it is 
to be remembered, that the louder rales will be carried farther 
than the feebler rales. Galvagni claims that rales in the deeper 
structures are heard most accurately from the mouth; others 
think such a statement requires modification; certain it is that 
rales in the apices are heard surprisingly loud if the stetho- 
scope be placed near the mouth. Rales have again been divi- 
ded into fine bubbling rales, coarse bubbling rales, and medi- 
um-sized bubbling rales. The distinction is valuable perhaps 
for determining the locality of the rale ; the fine usually will 
be generated, as we should expect, in the bronchioles, and the 
coarse in the larger bronchi and cavities. The fine uniform 
bubbling rale is more often known as the moist crepitating 
rale of Lsennec, such as simulates rubbing of the hair between 
the fingers, and belongs emphatically to the air-cells and 
bronchioles. It has been regarded as pathognomonic of pneu- 
monia, and is heard in the first and third stages of the disease. 
The significance is, that the alveoli contain both air and fluid. 
There is a point to be made in the regularity of the rales, as 
an irregular crepitating rale may be found in connection with 
condensation, — the rale coming from the smaller bronchi 
when the alveoli are impervious to air ; this crepitation is not 
usually affected by coughing, as the contents of the alveoli are 
not thus dislodged. It should be remembered that the medi- 
um-sized and the larger rales, which are always more distinct 



82 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

and louder than the smaller rales, are associated with the sim- 
ple and primary of the bronchi, and yet their chief import- 
ance in diagnosis consists in their being a frequent accompani- 
ment of secondary catarrh which is allied with parenchymal 
diseases of the lungs and with cavities. The rales themselves 
are not of a character to enable one to decide upun the ques- 
tion of condensation, but percussion and the character of the 
respirations, presumably will so far aid as to leave little doubt. 
The rales of a secondary catarrh which would be likely to be 
associated with caseous condensation however, are likely to be 
quite limited in distribution. Then as a rule they are of the 
medium size coming from the smaller bronchi and are not 
often appreciated by the hand. 

Resonant and Non-resonant Rales. — Resonant rales are 
always associated with condensation and cavities, while with 
a spongy texture the rales will always be non-resonant. The 
cause is apparent ; the dense structure favors the transmission 
of sound to the superfices, while the resonant quality is lost in 
passing through any considerable amount of lung expanded 
with air. It is not a fact, however, that all condensation yields 
us the resonant rale — should the dense part of the lung be ex- 
ceedingly limited then the lesion would be surrounded by lung 
substance still admitting air, and this would destroy the reso- 
nance. The most pronounced resonance comes from cavities 
situated superficially and near the thoracic walls, as these 
rales will be nearer the ear and more removed from tissue 
which deadens the resonance by containing air. In other 
words resonance is increased by proximity to the walls and 
the degree of condensation of lung tissue. 

Creaking Sounds. — We have creaking sounds associated 
chiefly with cheesy condensation of the apices which are valu- 
able to study. They are never heard except when the secre- 
tion is scanty, and then these sounds seem close to the ear. 
They are often observed for awhile, then disappear — perhaps 
on account of the bronchial secretion being arrested. Other 
means of determining the condensation, such as percussion 
and observing the character of the respiration, will be applied 
if these creaking rales are detected, for they might be found 
associated with a primary bronchial catarrh after all. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 63 

Metallic Rales. — The ringing metallic rales are the most 
.musical and accurate in pitch of all tones given out from the 
chest; they are best imitated by letting drops of water fall upon 
the bottom of a metallic vessel — they are always found in con- 
nection with cavities of considerable size and near the thoracic 
walls — precisely the same conditions which afford us the me- 
tallic percussion sound and the amphoric respiratory murmur. 

Auscultation of the Voice. — Auscultation of the voice is 
employed to supplement or corroborate opinions formed from 
auscultation of the respiratory murmur and percussion ; the 
sounds are classified as bronchophony and egophony. Bron- 
chophony is a normal sound in the larynx, but when found in 
the chest it invariably points to condensation or a large cavity 
in solid walls. By far the most common causes' of condensa- 
tion, as has been stated, result from caseous exudation and he- 
patization. In cavities formed from cheesy degeneration the 
bronchophony is more intense usually than when we have 
dilatation of the bronchial tubes. Gangrenous cavities rarely 
obtain to sufficient size to yield this phenomenon. In large 
cavities following caseous degeneration, there is frequently a 
metallic ringing character to the voice sounds — it is not so 
loud, however, as that which attends coughing. 

Phthisical patients so far advanced as to have bronchophony, 
are usually weak, and the voice is also weak and perhaps hoarse 
and feeble from laryngeal complications: these conditions mo- 
dify the voice sounds coming from cavities as would be ex- 
pected. Bronchial respiration and bronchophony arise from 
the same conditions and are always found associated ; they are, 
however, of unequal intensity. Lsennec designated the more 
exaggerated sounds in bronchophony, pectoriloquy, it is a 
term of no particular significance. Skoda speaks of faint and 
loud bronchophony, the loud being merely Laennec's pectori- 
loquy. As we have said, bronchophony is more distinct in 
cavities; yet infiltration under some circumstances yields quite 
as pronounced a sound. 

Baccelli has shown that the more fluid and homogeneous the 
effusion, the more readily and thoroughly will it be j)enetrated 
with the vocal vibrations, and that if circumstances favor, even 



64 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

a whisper will become audible through the effusion; while 
through fibrinous and purulent effusions the wave sounds pass 
with difficulty or not at all; hence it is claimed that it is quite 
possible to decide by the whisper whether it be serous, fibri- 
nous or purulent matter through which the vibrations are 
transmitted. It is advised that one ear be pressed firmly 
against the walls when we are to explore, while the other ear 
is stopped by the finger, and than that the patient turn his 
face from the auscultator and speak either loud, or in a whisper, 
or both. 

Aegophony. — This term is applied to a sound which has 
the peculiar tremulous character thought to resemble the bleat- 
ing of the goat. The sound produced by speaking against a 
comb covered with paper, or the twang heard when speaking 
with the nostrils closed, gives a very fair conception of the 
sound. 

Aegophony is produced, as it is thought, by the vibration of 
the walls of flattened or compressed bronchi; the voice vibra- 
tions being transmitted to a thin layer of fluid lying between 
the chest- wall and the lung; — moderate pleuritic exudation 
would give such a pathological condition. It occurs, according 
to Skoda, also in the absence of fluid, as it has been heard in 
cases of exudative hepatic pneumonia and in caseous conden- 
sation with and without cavities. It is not unusual to find bron- 
chophony and aegophony at the same points or not far re- 
moved. After all the aegophony may be considered as only 
a modification of a bronchophony. 



CHAPTER VII. 
SPUTA. 



The lungs may be extensively infiltrated with miliary tuber- 
cle and the sputa not be different from that in a bronchitis, 
because in the early stages the irritation only provokes an in- 
creased catarrhal secretion. Sometimes, however, before the 
disease has had a continuance sufficient for anything which 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 65 

looks to suppurative action, the microscope reveals the exist- 
ence of elastic fibres, which is conclusive evidence of destruc- 
tive wastes in the parenchyma, even if physical signs fail to 
detect condensation or tubercular degeneration. The presence 
of pulmonary epithelium, at one time, was looked upon as 
diagnostic of that form of phthisis which is usually designated 
as a desquamative pneumonia, but it is now known that epi- 
thelium of this character has been detected in the sputum 
which attends an attack of simple catarrh. The quantity of 
sputa ejected depends largely upon the extent and severity of 
the irritation, and in caseous degeneration the irritation is 
usually progressive, the sputa being scanty in the outset and 
very abundant in the latter stages of degradation. Should the 
disease be arrested temporarily even, the expectoration would 
also be arrested, and be very definitely modified by the pro- 
gress of the disease. Sometimes we have blood-stains and 
blood-streaks — hardly will these be diffuse; if these exist for 
any considerable time it is extremely suggestive of caseous in- 
filtration, and should be accepted as good evidence, even if the 
physical signs usually attendant are not detected. Prolonged 
expiration especially should be watched for as a corroborative 
sign, available even before auscultation and percussion in 
diagnosis. The sputum of cavities at once takes such peculiar 
character as admits of no mistake; it is of firm consistence? 
rounded in shape, of a dirty greenish or grayish color, and 
sinks, in water; possibly there might be blood mixed with the 
expectorated mass. There will be a quantity of mucus also 
contained in the sputum, as the mucous membranes will keep 
up their secretions as before the cavity formed. It is even 
quite possible that the quantity of mucus may be in such pro- 
portions as to hold up the purulent portion in water, because 
of the quantity of air-bubbles confined in the expectorated 
matters. Cavernous sputa examined with the microscope re- 
veal pus-cells, free nuclei, elastic fibres and other debris of the 
destructive process. Should the sputa from any cause be re- 
tained for any considerable time in the cavities, changes most 
likely would occur, tending toward a septic nature, and fer- 
mentation would break down more 01 less the cohesiveness, 



66 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

and an offensive odor would follow, the sputa taking on a 
muddy, dull color. 

Putrefaction in tubercular cavities, however, is much more 
rare than in bronchiectatic cavities, as the cavities from tuber- 
cle usually are more superficial and in the upper lobes, while 
bronchial dilatation is usually in the smaller bronchi, and sit- 
uated in the lower lobes, making expectoration more difficult. 

Septic degradation in bronchitis with dilatative and gan- 
grenous destruction of the lung-tissue, presents about the same 
quality of sputa ; it differs in both cases from cavernous sputa 
arising from tuberculous action ; in that it contains few or no 
elastic fibres; evidently there is an element in the sputa which 
chemically destroys the elastic fibre. Though the sputa of 
tubercular cavities has not the tendency to putrefactive degra- 
dation that exists in bronchiectosis and some kinds of inflam- 
mation of the parenchymatous tissue, such as sometimes follows 
pneumonia, or such as comes from inhaling poisonous vapors 
and from causes which debilitate and degrade the blood, yet 
we must regard that septicemic influences have not a little to 
do with the fatality of phthisis. The study of the sputa then 
is valuable for the purpose of following the progressive advance 
of the tubercular transformation. 

Then we may classify the expectorated matter into mucous 
sputum, which consists of the normal elements of the secret- 
ing mucous glands, mucous, water, and albumen in small quan- 
tities, albumen always abundant when inflamniatory action 
sets in; muco-purulent sputum, which contains pus cells in 
addition ; and the purulent sputum which closely resembles the 
pus discharged from an abscess. These constitute the base 
constituents of all sputa. If blood be mixed it may be called 
sanguiniolent, to indicate such fact, though blood constitutes 
but a small part of the elements — more proper would it be to 
say sanguinio-purulent or sanguinio-albuminous. 

Gangrenous sputum is somewhat distinct, especially in odor 
and possibly the addition of parasites, though probably these 
are accidental and not elementary. The appearance however, 
is different. The sputum is usually thin and abundant, of 
brownish or dirty green, or yellowish-green color, and sepa- 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 67 

rates into three strata on standing; the upper layer is frothy, 
opaque and greenish; the middle is of a glairy albuminous 
character, even almost a serous matter, while the bottom is 
yellowish opaque matter, composed of pus corpuscles and a 
detritus forming yellowish-white cores which are very fetid, 
in which are found needle-shaped crystals of fatty acids. Gan- 
grenous sputum rarely comes from tubercular cavities. Dilated 
bronchi, emphysematous cavities and degradation of tissue, 
blood thrombus, or burrowing abscesses formed from inhaling 
sewer gas or other noxious agents, are the more common 
causes of this sputum; it follows also from breaking down of 
the lung tissue in the third stage of pneumonia. Elastic fibres 
and blood stains, frequently appearing, then, may be regarded 
as of great importance to note, as they are found early, often 
before other physical signs can be made available for a diag- 
nosis; they are very significant and appear at a time when 
remedial agents and proper regimen promise most for our pa- 
tients. The sputum indicating progressive destructive wastes 
later on may still be studied for the purpose of selecting the 
proper remedy, the extent of the pathological lesion and prog- 
nosis; though the last by most will be thought to be a very 
easy matter. 



CHAPTER IX. 



IMPORTANCE OF EARLY RECOGNITION OF 
PHTHISICAL TENDENCIES. 

As a morbific influence phthisis often proceeds far along in 
the work of disintegration of molecules if not of structure, 
before tubercular deposit follows ; although tubercular deposit 
is almost a constant concomitant in the retrograde movement. 
Great emaciation, extreme nervous irritability and motor in- 
capacity are often reached with little, if any deposit of tubercle. 
We cannot be too much on the alert for the first expression of 
vital deterioration, and retrograde tendencies in morphological 
movements. The arrest of these early vital and molecular 



68 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

movements which tend to locate a morbid focus in the lungs, 
should be our first and chief care. It is not necessary to wait 
till anscultation and percussion reveal the indications of tuber- 
cular deposit before we are able to say whether there be steps 
taken in the phthisical dyscrasia toward degradation of vital 
force and the plasma. Indeed we may have tubercle in the 
lungs, and the expert in physical diagnosis fail to detect such 
a condition ; but in saying this we do not wish to underrate 
the value of physical exploration in this disease. 

PRODROMIC SYMPTOMS. 

Among the earlier and perhaps the symptom of first im- 
portance is weariness. Patient says, I wish I could once get 
rested; feels too feeble for doing anything; particularly wearied 
and out of breath on going up hill or up stairs. At this stage 
may also be noticed the delay in expiration while breathing ; 
the expiration being relatively longer than the inspiration. 
Then follows the constantly increasing muscular attenuation 
the liability to take cold, the short, dry, hacking cough, the 
complexion showing that the coloring matter of the blood is 
also diminishing, for this pallor comes in the early stages 
almost uniformly. If your patient is connected with a phthi- 
sical family, these symptoms are all the more significant. If 
they come from any unexplainable source they are of the 
gravest import. If they follow an anaemia or exhausting 
draughts upon the constitution there is not a moment to 
be lost. Whatever the antecedents the case has reached a 
critical period. 

At this stage the appetite is likely to be capricious ; some 
articles of food are taken with a relish, perhaps, while others 
are loathed. In young girls suffering from menstrual disor- 
ders, who have phthisical tendencies, especially is this the 
case. In not a few, there seems to be a dislike of fatty foods ; 
perhaps they will relish butter and dislike other fats. Then 
there is a class who eat well but constantly lose flesh. They 
are nervous, irritable and apprehensive ; a condition of mind 
in exact contrast to what is seen at a later stage of the disease. 

Activity of Mind. — DaCosta and others remark upon the 
great brilliancy of the mental faculties, and some mention it 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 69 

as a premonitory symptom. Our observation is, that very 
promising persons as to their mental gifts, often fall a prey to 
this disease, and we remember cases where this mental activity 
seemed to precede by a few months, well declared symptoms of 
phthisis. If the symptom found corroboration in family his- 
tory, or by other prodromic symptoms, we would attach much 
importance to it. 

Hoarseness. — We have noticed that many of our cases 
treated for aphonia died later of pulmonary phthisis ; some- 
times not for years, however. Hoarseness may be looked upon 
with suspicion when it is chronic, or when repeatedly occur- 
ring in persons of delicate health ; especially if they have ob- 
stinate catarrhal attacks with coughs which are difficult to get 
rid of. No doubt chronic laryngitis is often suggestive of in- 
cipient tuberculization of the lungs. According to Cohen 
and other laryngoscopists, even tubercle is often detected in 
the larynx before physical examination shows any invasion 
of the lungs. 

Cough. — A cough is often the first thing which attracts at- 
tention ; it is much more constant than hoarseness and may 
exist for many years, but never loses any of its significance. 
It is usually a dry irritative cough, sometimes of a loud bark- 
ing or explosive character. Possibly it may be only a mere 
hack with an inclination to clear the throat of some viscid 
secretion. At this time it is doubtful if it be more than a 
catarrh where the walls are only a little thickened ; but we all 
know the significance of a catarrh, especially when lodged in a 
scrofulous diathesis. 

Temperature. — Temperature is of very great value in rapidly 
developing phthisis, as an early symptom, it is of less value in 
very slowly developing cases of phthisis. Prof. Flint says : 
"Increase of the temperature is evidence for, and absence of 
any increase, is evidence against the existence of the disease." 
Usually, and perhaps always, there will be found periods of in- 
crease of temperature, before physical signs indicate tubercle ; 
and, as has been stated, these vary as to the time of appear- 
. ance and in the degree of fever expressed. If the temperature 
be high it indicates rapidity of disease, extensive tubercular 
invasion and early softening of tubercle. It is important to 



70 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

take the temperature night and morning, and for a week or 
two, if we would have much value attach to this symptom. 
The morning temperature may even be higher than the even- 
ing, which would be an exception, and this fact can only be 
known by a comparison. The temperature may vary one day 
with another, and this can only be determined by taking the 
temperature sufficiently long, to get at an average; and the 
remission of the fever itself, may be important if found. If 
the temperature taken in the axilla is maintained as high as 
99° for a few weeks, it is indicative of tubercular troubles; and 
if it is supported by other symptoms or occurs in a constitution 
seemingly predisposed to consumption there is reason for grave 
apprehension. 

SUGGESTIONS FOR MANAGEMENT. 

The whole regimen needs prompt attention, the totality of 
symptoms need careful study, the proper remedy needs to be 
selected and judiciously given. It may be Phosphorus, it may 
be Sulphur, or it may be Zincum, or some other remedy more 
fully covering the symptoms. Good air, good food, warm 
clothing, plenty of sunlight and plenty of sleep are now in- 
dispensable. And yet, the homoeopathic agent, taking the 
rank of the similimum, is our lever and the great thing on 
which to rely. No morbid element or factor can be over- 
looked. Mastery of the totality of symptoms must be made 
if we expect any success; not the outward symptoms alone, or 
chiefly, but the dyscrasia, the radix, and the most occult 
vital impediment. It is of much less importance in a thera- 
peutical sense to determine the location of a vomica than to 
differentiate and classify the objective and subjective symp- 
toms concerning the cough, sputa, complexion, aggravations, 
ameliorations, etc., so as to be able to give a remedy which 
shall so act upon the vital movements as to arrest this retro- 
grade process. Well as it may be for one to be skilful in all 
the methods of physical exploration, this other study of vital 
expression is indispensable. Certain it is, there is no excuse 
at this day for a man's being ignorant in our methods of phy- 
sical diagnosis. If he cannot tell, as a rule, if he have tuber- 
cular dulness, bronchophony, aegophony, or pectoriloquy, he is 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 71 

not to be commended for his learning, and yet there are 
weightier matters; yet, it may be doubted if one knows noth- 
ing of physical diagnosis, if he will be a very good diagnosti- 
cian on higher grounds. We must know it all, pathology is a 
part of the totality of conditions, and is not to be separated 
from the symptoms. The first step in a large class of our cases 
will be to eradicate the constitutional dyscrasia, or to eliminate 
from the system such impedimenta as put progressive vital 
movements under arrest. This dyscrasia, no doubt, is what 
Hahnemann would often express as a psora, having a much 
broader significance than scabies or its family implied in the 
term. Faulty assimilation, and faulty excretion, are to be at- 
tended to, and faulty excretion may often be the antecedent of 
faulty nutritive preparation and assimilation. All impedi- 
menta tend to functional inertia, and functional inertia to low 
grades of vital activity or poor health, the earlier retrograde 
steps to the later and more serious disintegrations. Then, 
attack the tubercular dyscrasia, the psoric-dyscrasia, or the 
hydrogenoid-diatheses, or whatever name be given to it, in its 
most latent form ; acting upon the principle of tubercular pre- 
vention as the first duty of the physician. Outside of thera- 
peutical prescriptions, much may be done in grading our vital 
status up by proper choice in marriage alliances, a matter for 
every well-wisher to his household to think of, and for students 
of sociology to study. Tuberculosis on both sides will surely 
bring death to offspring. Training for muscular development, 
which antagonizes somewhat the tubercular diathesis, is another 
way of overcoming danger. Muscular development and ac- 
tivity divert fibrin from the overcharged vessels in the lungs, 
and relieve the damming up process so favorable to tubercular 
exudation. Too much brain work must not be put upon grow- 
ing persons, or even upon older persons with tubercular ten- 
dencies. Free expansion of the lungs and liberal activity of 
the muscles clear the stasis in the capillary and venous vessels, 
and the oxygenoid processes will go on more completely, work- 
ing up fibrin to a condition adapted to structure building, and 
separating the unallying and effete matters, and giving them 
a current toward the eliminating channels. Abundance of 
sun, air of a high electrical status, giving a dry atmosphere 



72 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

instead of a moist, is an adjunct. A systematic practice of ex- 
panding the lungs to their full capacity by the spirometer is of 
considerable value, as by such efforts at keeping the air-cells 
open, they are less likely to become the receptacles of cheesy 
deposit. It is a noticeable fact that tubercle has a facile 
tendency to infiltrate into the tissues of the apex of the lungs, 
and may not this be explained largely upon the generally 
feebler expansion of the cells at the apices? 

Comprehensively, reserve force is to be carefully economized, 
and so far as may be built up and accumulated, while over- 
work and every devitalizing influence is to be avoided. 



CHAPTER X. 



DIFFERENT CAUSES SUGGEST DIFFERENT 
TREATMENT. 

Whether we are to alter our opinions upon the nature and 
curability of that disease which has from time immemorial 
been the scourge of our race and the opprobrium of the pro- 
fession, in the advancing light of science, is a question which 
our moral courage should permit us at least to consider. Pos- 
sibly we have emphasized the difficulties of the situation from 
taking our data too much from one class of cases, and that the 
worst class. Autopsies reveal more cures, or arrest of advance 
at least, in descending transformations, than had been sup- 
posed to exist. Have we given sufficient scope to our investi- 
gation of causes? Indeed, have we not laid too much stress 
upon hereditary transmission of the disease we call phthisis, 
and overlooked the accidents of arrest of nutrition and elimi- 
nation, particularly the last? Suffice to say, that it seems to 
us that the causes of phthisis are various, and possibly the 
pathology may yet have to undergo a revision. Any foreign 
substance acting as an irritant to the lungs may finally end in 
destruction of tissue and the degradation possibly may take 
the course of caseous exudation. We once knew a young man 
who by accident drew into the air-passages a portion of the 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 73 

husk of a beech-nut; it lodged at the bronchial bifurcation, 
provoking a violent cough for two years or more, and slight 
hemorrhage at times. At length it was coughed up, but it 
had provoked tubercular deposit, of which he died within the 
year. There might have been some slight predisposition to 
tubercle, but inflammations cause infiltrations of fibrin or fib- 
rinoid matter into the lungs, and this has a tendency to un- 
dergo degrading transformations and open up pus receptacles 
to be followed by all the results of retrograde metamorphosis. 

It is hardly denied that tubercle is a constant accompani- 
ment of phthisis proper, but this tubercle possibly may be an 
incident of the disease. We are almost inclined to think we 
can have a nervous phthisis, no tubercle existing till the 
phthisis has been long set up. We dare not deny death may 
occur before the stage of deposit. We find a large per cent. 
of consumptives in districts where many of the inhabitants 
are confined in manufacturing establishments, breathing the 
dust of mills, much of it dust from cotton and woolen fabrics. 
Probably such a life meets more often the extremes of heat 
and cold, which of course tends to congestions and disturb- 
ances in the vascular vessels. Pneumonias follow, possibly 
tubercle even in good constitutions. 

What we breathe into our lungs, no doubt has much to do 
with their soundness. Indeed, we may say that this is no 
longer a question, pathological study having fully settled the 
fact. An eminent student of pathology has declared that the 
number found with affected lungs is surprising, and that in- 
haled particles of dust of one fabric and another is clearly the 
cause of the largest per cent, of all diseases, and especially of 
consumption. A climate subject to extreme changes is a very 
common cause no doubt, as congestions, catarrhs and pneumo- 
nias, are often the admitted antecedents of consumption. We 
have kept the record of a large neighborhood in a town of 
New England for over forty years, and, to our surprise, more 
of its citizens have died of consumption than all other diseases 
put together. The neighborhood is located upon a plateau of 
high land sloping southeasterly for the most part, and the bal- 
ance occupying a basin at the foot of a mountain range — the 
6 



74 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

stream flowing south through the valley. We do not suppose 
this is exceptional. Several cases did not seem to trace to any- 
hereditary predisposition. In one instance the person had been 
attacked several times with pneumonia and did not die till 
past fifty ; a brother died of pneumonia not far from fifty-five ; 
the parents died quite old; several sisters and a brother are 
living now and quite along in years. Still another case, that 
of a young lady, set. about twenty-one; she had hemoptysis 
and died within a year and a half; father died of fever and 
mother lived to be very aged. Three brothers and three sis- 
ters, most of whom are living yet, never showed the least trace 
of tubercular troubles, and these cases can be duplicated in 
the same neighborhood. In another family one daughter and 
three sons died of consumption, while one daughter escapes 
so far; and a son nearly sixty is living, but has a bronchial 
trouble of a serious nature. The father and mother both lived 
up to eighty or more years. At the time the children were 
being carried in utero the mother was intemperate as well as 
the father. Consumption afflicts the second generation in this 
line in two families, that of the eldest son who died at about 
fifty years, and the second son who died a little younger. The 
third son who died even earlier in life had no family so far as 
known. It looks very much here as if alcoholism was able to 
so far vitiate the evolutionary force as to insure early retro- 
grade metamorphosis, which in this case took the course of 
caseous degeneration of the lungs, and also carried a heredi- 
tary bias with it. We have known thoroughly the history of 
several cases in different localities where syphilis had been 
contracted, that ended in pulmonary consumption with syphi- 
lization and tubercularization conjoined, and part of them did 
not seem to have any particular predisposition to phthisis ; 
one case, that of a woman, who was one of a family of eleven 
children, parents living to be seventy-one and seventy-eight. 
The other children are still vigorous, many of them well along 
in years. 

We have known other cases where gonorrhoea developed a 
phthisis out of its own root, or provoked germs of scrofulosis 
quite too latent to be recognizable by any symptoms or his- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 75 

torical proofs in family genealogy. We do not say that such 
cases follow the identical course of a scrofulous phthisis, but 
they end with pathological lesions, and other phenomena so 
thoroughly alike that we are unable to draw the lines at least. 
Rindfleisch would say, these were stimuli to latent infections. 
A phthisis developing out of a syphilitic taint, is apt to be 
slower in progress in the second and third stages, we should 
say, than a phthisis developed from scrofula per se. Some 
may doubt if such cases should be called pulmonary phthisis; 
well, we have tubercular degeneration and cavities. We say 
that a phthisis developing out of a pneumonitis is not a phthisis 
direct, but we have tubercle and cavities, and the same septi- 
csemic influences followed by death. The beginning is differ- 
ent but the end the same. This is the point we are laboring 
to show. A case is not studied in its totality till every element 
is also well studied. Hahnemann studied thus the totality of 
the constitutional morbific forces. 

Experience must determine how far Aurum muriaticum, 
Kali hydriodicum and Nitric acid can be made to aid in the 
restoration of the vital forces in a phthisis pulmonalis with a 
syphilitic antecedent. We have no doubt but that these agents 
in such cases will be much more frequently indicated than 
Phosphorus, which is so efficient in cases arising from pneu- 
monitis, or than Sulphur, so widely applicable to many forms 
of chronic disease, especially the catarrhal and those arising 
from faulty elimination. In cases where measles, or any other 
eruptive disease seems to be the provoking cause, we need to 
study the case by giving due importance to the unknown 
morbific force which was declared first in the rubeola, or 
variola as it may be; and what is known in therapeutics as 
corrective of these morbific forces may find a further adapta- 
bility in the degradation whose focus is the lungs. So of gon- 
orrhoea we may look for Mercurius or Thuja to serve beyond 
other remedies in the tubercular complication. We do not 
say that generalization shall take the place of symptomatology, 
that we are not to give the best indicated remedy from the 
standpoint of subjective and objective symptoms, especially 
the first, these being the highest in rank. But very likely our 



76 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

case will agree in this totality, and possibly subjective symp- 
toms will be very deficient. If our course of reasoning is 
correct, it is easy to see that no one remedy can be a panacea 
for tuberculosis of the lungs; cod liver oil, phosphate of lime 
and soda, or anything else. Each case must be individualized 
and treated in its totality. Treating our cases by including 
the totality of the symptoms, the history and pathology being 
a part of that totality, we should naturally conclude that cases 
arising from different causes and with different phenomenal 
progress, would require different remedies for treatment. To 
instance another class of cases, consumption dating its begin- 
ning from a malarial poison, would more naturally suggest 
Arsenicum, Lycopodium, or Natrum muriaticum, than Stan- 
num or Sulphur, and presumably the out-cropping phenomena 
would better correspond to the provings of these remedies. 
For the more purely scrofulous cases, with faulty nutrition 
and glandular obstructions, to meet temperamental defects and 
hereditary bias, those agents used for the removal of the deepest 
chronic dyscrasias will naturally suggest themselves. With 
this interpretation of phthisis the element of hereditary trans- 
mission will not attach in all cases, although the law of nature 
which tends to a perpetuation of types is admitted. Consump- 
tion thus studied and thus treated, we apprehend, will prove 
the triumphs of science instead of standing a perpetual oppro- 
brium upon our art. 



CHAPTER XI. 



AMENORRHEA, OVARITIS AND ENDOMETRITIS 
AS CAUSES OF PHTHISIS. 

The non-appearance of the menses at the age of puberty 
has its cause usually in some cachexia; such faults of second 
assimilation as show themselves in rachitis, chlorosis and scro- 
fulosis very likely may be at' the bottom of the difficulty. In 
some cases the ovaries degenerate and become atrophied; very 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 77 

often the amenorrhoea is associated with a general ansemia; 
there are associated with these cases as a cause or as a com- 
plication, chronic infarctions of the womb and oviducts, the 
result of catarrh or a uterine lymphangitis. These troubles 
need to be successfully treated to save invasion of the lungs in 
the end. It has been ascertained that the spontaneous move- 
ments of the white blood corpuscles are dependent upon the 
oxygen imparted to them from the red corpuscles. In chloro- 
sis the red corpuscles are rapidly depreciated, and the oxygen 
bearing capacity is greatly reduced. It is fair to suppose that 
as the spontaneous movement of the white corpuscles ceases, 
they will impact in the minute capillaries. And as the apices 
of the lungs present a favorable point for" the lodgment of 
such corpuscles, possibly we may get cheesy exudation in this 
manner. We have often noticed how quickly the lungs become 
attacked from certain forms of amenorrhoea ; of late years also 
we have had occasion to note how very frequently cases of 
pulmonary phthisis followed the treatment of uterine catarrh 
by astringents and cauteries. No doubt some of these cases 
have a scrofulous groundwork at the beginning; if so, all the 
more important that the treatment should be constitutional 
and not local. The scrofulous element is less dangerous act- 
ing as a uterine lymphangitis than as a tubercular attack of 
the lungs, and there is no doubt but that there is danger of 
metastasis from such treatment. Perhaps it is only fair to say 
that such treatment is likely to convert a rnild form of lym- 
phangitis into an intractable one, and that such intractable 
catarrh tends to break down the nervous system, impair the 
digestion, and bring on such debility and blood degradation 
as paves the way to a phthisis. I fear untold harm is being 
done by such pernicious treatment of our cases of uterine lym- 
phangitis and chronic catarrh. Then if we are not greatly 
mistaken, the indiscriminate use of iron in large doses for 
amenorrhoea and chlorosis has only tended to aggravate the 
difficulties for which it has been given, and all the more cer- 
tainly to bring on tubercular complications. So strong are 
our convictions of a need of reformation here, that I have 
deemed it proper to devote a few pages to an analysis of the 



78 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

leading remedies which experience has shown to possess a 
curative value in this class of cases. 

Alumina. — The anaemic state to which Alumina so well cor- 
responds, makes it a remedy suitable for chlorosis, and other 
conditions, where the menstrual function is deranged in a way 
to threaten pulmonary complications. The menses delay or are 
absent, color pale, quantity very scanty; leucorrhoea: acrid, pro- 
fuse, and light colored ; usually alleviated by cold washing. There 
are throbbing pains in the vagina upon the left side ; stitches in the 
vulva upon the left side, extending by sympathy into the chest. If 
the lungs become implicated, the cough is dry and hacking ; 
worse from talking or singing, often causing pain in the right 
temple or on top of the head. There is an oppressive pain which 
is worse at night; often stitches in the chest from right to left 
(Lycopod.), in the afternoon — hoarseness or aphonia, and if any- 
thing is expectorated, feels as if torn away and after tedious cough- 
ing. Alumina patients are apt to wake with palpitation of the 
heart — often have to strain a great deal in voiding urine; pass it 
best when at stool; sometimes contrariwise, cannot cough with- 
out involuntary urination ; possibly have pain in the back as 
if a hot iron were being run through it; agrees with thin dry 
people and women greatly prostrated by menstruating. Ap- 
petite is perverted, wanting chalk, charcoal, cloves, tea-grounds or 
some indigestible and unnatural substance. Aggravations on al- 
ternate days; after dinner, when in out-of-door cold air, also 
from using wine, vinegar, salt and pepper. 

Apium virus. — Will be found an important remedy when 
the morbid expression commences in the right ovary and de- 
velopes lung symptoms. 

The right ovary is swollen, painful, with pains passing down 
the thigh, or with soreness in the upper portion of left lung, 
attended with a cough. The pain may extend up to the ribs 
on the right side from the ovar}' - . There is often a numb feel- 
ing in the side or down the thigh ; the urine is apt to be scanty; 
• the stool scanty and difficult, or possibly a diarrhoea of a wa- 
tery character and foul smelling. 

Accompanying symptoms are: menorrhagia with faintness; 
suppression of the menses; amenorrhcea; dysmenorrhea; leu- 
corrhoea which is profuse, acrid and green. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 79 

Calcarea carb. — Those who have been broken down by 
frequent and too profuse menstruation, or by frequent miscarriages, 
or too rapid child-bearing, will often be benefited by Calcarea 
carb. Patients are easily out of breath on going up stairs, 
have to sit down, they are so much fatigued and out of breath; 
they catch cold easily; have damp feet; do not sleep much after 3 
A.M.; are often troubled with watery whitish diarrhoea; a leu- 
corrhoea like milk ; cervical glands swell ; skin is flabby and 
soft; pains are aggravated by the slightest touch or noise; 
cough is dry at first with profuse salty sputum later. The 
later symptoms with advancing phthisis will be found under 
the heading of Calc. carb. in a subsequent chapter. 

Guernsey gives the symptom, "least excitement causes the 
menses to return." Marcy and Hunt, "albuminous leucorrhoea, 
from the cervical canal, with great lassitude, debility, sinking, 
and trembling at the pit of the stomach, and burning pains 
in cervical canal." Dunham says : " The menses occur too 
early and are too copious often in incipient phthisis." Also 
that the leucorrhoea is apt to be " worse before the menses." 

Conium mac. — The action of Conium upon the glandular 
system, and upon the genitive system of woman, suggests its 
adaptability to morbid states which have a tubercular tendency. 
The symptom, pain shooting into the left chest when dysmen- 
orrhoea exists, shows a tendency of the lungs to sympathize 
with uterine troubles. We have inflammations of the ovaries 
and mammae, enlargement of the ovaries and nodes in the 
breasts amenable to the action of Conium. Mammae are sensi- 
tive before menstruation. Then again mammae shrink away 
while the sexual appetite is active. Pains in the uterus are 
stinging in the neck and aching in the fundus. Stitches in 
the vulva is another symptom of Conium. Harley recom- 
mends it for exhaustion of the sexual organs. It is adapted 
to scrofulous persons of a rigid fibre. Hughes gives the symp- 
tom, "hacking, almost continual, cough; worse at night, when 
lying down." Hering, "hard cough, excited by itching or 
tickling in throat and chest, also bloody sputa, purulent sputa, 
sputa of putrid taste and smell. A remedy for single women 
along in years and light-haired persons." 



80 PHTHISIS PULMONALISI TUBERCULAR PHTHISIS. 

It would seem to be best indicated for such cases as tend to 
atrophy or indurations ot the ovaries or mammae, consequently 
showing a degree of arrest of the reproductive functions, and 
for such as have dysmenorrhea, with pains in the lungs, or 
hemoptysis. Also to a spasmodic cough which is worse even- 
ings and when lying down. The cough is provoked by tick- 
ling or itching in the chest or throat. 

Ferrum met. — I am sure that the use of iron in large doses 
often excites the vessels of the lungs to tubercular activity. I 
have personally observed the fact under circumstances not ad- 
miting of doubt — and if large doses of iron will occasion the 
exudation of tubercle, why may not the infinitessimal arrest the 
morbid activity which developes tubercle? I think we might 
find the use of Ferrum in the 30th attenuation upward a very 
valuable remedy in certain cases of phthisis. I do not think 
it is worth anything below that any more than Sulphur, and I 
have seen astonishing results from the 100 m. of Sulphur when 
the 30th had apparently no effect. 

For hemoptysis from suppressed menses I think we have 
no better remedy, it being understood always that the simili- 
mum is the remedy par excellence. In Ferrum hemoptysis the 
blood is usually bright colored, readily coagulates, and not un- 
frequently it is accompanied with interscapular pains; some- 
times there are flying pains in the chest; pulse is rapid, breath 
short, and hands tremble; countenance either pale, greenish- 
pale, or pale with spots; the sputum in advanced cases of lung 
trouble is copious, putrid and purulent, or greenish and frothy 
with purulent globules intermixed. Patient raises most in the 
morning and when moving about ; is troubled to raise at 
night, unless she sits up in bed. Guernsey gives the symp- 
toms : " Weakly persons, with fiery-red face." " Least motion 
or exertion produces a red, flushed face." "Anaemia, with pale 
face and lips, with great debility." " Face becomes suddenly 
fiery-red, with vertigo; ringing in the ears; great palpitation 
of the heart and dyspnoea." "Vomiting of food, with fiery- 
red face; vomiting of ingesta after every cough." "Previous 
to menses, has stinging headache, ringing in the ears, and dis- 
charges of long pieces of mucus from the uterus." " Leucor- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 81 

rhoea like watery milk, smarting and corroding the parts when 
first appearing." " Menorrhagia in weakly persons, with fiery- 
red face. It occurs too frequently, is too profuse, and lasts too 
long." " The menses intermit two or three days, and then re- 
turn, the blood being very pale." "Hemoptysis, and spitting 
of blood" are mentioned by both Guernsey and Hering. Lippe 
speaks of a "general hemorrhagic tendency." The tempera- 
ment and concomitant symptoms corresponding to Calc. carb. 
and Ferrum it will be seen are very unlike, though the exces- 
sive menstrual flow is quite alike. 

Iodium. — From its influence upon the glands, both large and 
small, we might naturally suppose that Iodium would find a 
place in the treatment of ovarian troubles and also in dis- 
eased lymphatics, whereby the products of nutrition are lim- 
ited. Admitting that tubercular products are the result of a 
lymphangitis as some seem to think, it is no strange move of 
the morbific force acting upon the glands of the genital system 
of a woman, to set up also a morbid seat upon the mucous glands 
of the respiratory tract. Iodium seems called for in persons of 
low cachectic condition of the system; such as arises chiefly 
from scrofula. Persons incline to emaciate, even while eating 
well. The mammas dwindle in particular, are sensitive and 
sore. Women of this habit either menstruate excessively or 
not at all. If amenorrhcea exists they are very apt to show 
tubercular troubles of the lungs in a short time. The pulse is 
rapid, and there are other indications of pulmonary troubles, 
such as out of breath from little exercise, and an unexplainable 
weakness and languor is felt. 

Further uterine symptoms are, acrid leucorrhcea, more pro- 
nounced just after the menses, so acrid as to perforate the linen. 
The right ovary is more often the seat of trouble. Iodium pa- 
tients are usually very restless and want constantly to change 
their position (as in Rhus). Troubled also with canine hunger, 
eating very frequently. Their hunger may alternate with loss 
of appetite. 

Iodium patients are liable to pulmonary hemorrhages and 
congestions. Have the sensation of weakness in the chest, as 
in Stannum, but less marked; also sharp, quick, piercing pains. 



82 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

Cough more frequently a dry morning cough, with tickling in 
the larynx or burning in the thorax. Expectoration saltish, or 
sourish in taste — gray or white in color. Also large quanti- 
ties of mucus streaked with blood have been observed. Voice 
is hoarse and larynx sore. 

Guernsey speaks of empty eructations and a saltish taste in 
the mouth. Hughes speaks of its use in constant inclination 
to cough from tickling in the trachea and under the sternum, 
with emaciation and wasting fever, rapid pulse and diarrhoea. 

Lycopodium. — The action of Lycopodium upon che ovaries, 
especially upon the right, has for a long time been well under- 
stood. It. has been gaining clinical importance recently in 
the treatment of consumption. The two facts suggest that we 
are likely to find cases where it will be of great service when 
lung troubles seem to have arisen from menstrual derange- 
ments. The flatulency affecting the stomach and bowels; the 
urinary sediments; transverse character of pains or affections 
affecting the upper right and lower left sides, are often accom- 
paniments pointing to Lycopodium. The leucorrhoea, if pres- 
ent, is usually excoriating, bowels constipated. Patients are 
subject to sharp, cutting pains in the limbs, are sensitive to 
cold air, and are apt to emaciate, especially in the upper part of 
the body. The cough often seems to come from the stomach which 
is usually a sympathetic point; appetite is poor, or stomach 
fills up quickly if one attempts to eat; pyrosis or burning at the 
pit frequently exists as a complication. Expectoration is of 
a grayish-yellow or greenish-yellow and purulent color, tasting 
saltish. Cough worse evenings, or night and morning. 

"A woman of lymphatic temperament has for a long time 
suffered from a cough. Symptoms : cough getting worse, aggra- 
vations morning and night, expectoration copious, yellowish- 
green, purulent and of salty taste; occasional stitching pain in 
the chest; very weak; night - sweats ; looks more and more 
miserable every day; little appetite; burning at the stomach; 
bowels constipated ; moving every 3 or 4 days ; excoriating fluor 
albus ; cannot bear a current of air; shifting rheumatic pains; 
had taken Nat. mur. and Calc. Gave Lycop. 30 every day, then 
every two days; relief after the first dose, then improvement 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 83 

in the cough, disappearance of the night-sweats, gradual lessen- 
ing and eventual cure of leucorrhcea. Discharged cured in eight 
weeks." — Krussler, in Allg. Horn. Zeitung, xxix., 122. 

Dunham mentions the symptoms : "Menses too profuse, antici- 
pate a little; preceded by flatulent distention of the abdomen; 
great weariness of the legs; chill and heat at night; ill-humor 
and disposition to weep. During the menses, acid taste, head- 
ache, severe backache; swelling of the feet, nausea and a kind 
of faintness. Leucorrhcea in spells; of a blood-red color." 

Guernsey mentions "cutting pains across the body from 
right to left." 

Murex purp. — With the genital symptoms of Murex we 
have pain going into the lungs, which indicates a strong sym- 
pathy. It corresponds to that depression which often accom- 
panies uterine diseases occurring in one naturally given to 
cheerfulness and elasticity of spirits. The most noticeable symp- 
toms are, strong sexual desire which is greatly intensified by 
touch of the genitalia; pain in the right side of the uterus 
going into the abdomen or thorax (pain often crosses the body 
and ascends to left mamma) ; pain in the uterus as if cut by a 
sharp instrument; throbbings in the uterus; menses, after 
flowing a few days, stop and reappear after twelve hours. 

Concomitant symptoms are, thick and greenish or watery 
leucorrhcea; urine has an odor like valerian; great lassitude 
and feebleness in the body and limbs as well as the mind; 
" all gone " feeling in the pit of the stomach ; patient feels that 
she has a womb, giving her great discomfort. It is well known 
that many of our consumptives are given to strong amatory 
desires; in such cases it would be well to consult Murex. 

Pulsatilla. — There is a class of cases with blood-spitting or 
pulmonary hemorrhage and severe coughs, which the physician 
frequently meets with, arising from menstrual troubles, liable 
to end in the gravest results to the lung-tissue, which call for 
Pulsatilla. The mild tearful disposition; peevishness; flying 
pains ; light complexion and blue eyes ; the chilliness even in 
a warm room or whenever the bed-clothes are stirred, and yet 
wanting the out-door air; the inclination to yawn; bitter taste 
in the mouth after drink or food; thirstlessness, or thirst for ale 



84 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

and spirits; aversion to milk and fat food; nightly aggrava- 
tions; beginning of trouble after a menstrual excitement or 
when the menses have been suppressed; perhaps before they 
appear, are sufficiently indicative. Hysterical symptoms; op- 
pression of the chest when walking up hill or going up stairs ; 
irritation at the pit of the stomach which causes coughing, per- 
haps vomiting, are frequent accompaniments. The blood, 
if we have blood-spitting, is dark and usually coagulated. 
Hering recommends Pulsatilla in phthisis florida occurring in 
chlorotic girls, even when in the suppurative stage of tubercle. 

"In one case Pulsatilla in repeated doses, cured a cough 
with expectoration of blood, which had existed for three 
months; the cough and blood-spitting having made their ap- 
pearance after the cessation of the menstrual flow, and had 
not yielded to any other remedy. The expectorated blood 
was mostly dark, in coagula, mainly at night, the cough was 
tormenting and constant all through the night, making sleep 
impossible, with dyspnoea and stitches in the left side of the 
chest; feet always cold. While using Pulsatilla both hands 
became covered with herpes which disappeared again after, 
several months." — Knorre, in Allg. Horn. Zeitung, v. 31 0. 

Dunham sums up the leading uterine symptoms thus : " In 
the hypogastric zone, drawing, pressing or constricting pains, 
like labor pains, converging toward the pudenda. Pains re- 
lieved by crouching forward. They come, generally, just before 
the menstrual period, are attended by a feeling of weight, like 
a stone, in the hypogastrium, and accompanied by chilliness, 
stretching and yawning. The menses are delayed, difficult 
and scanty, or even fail altogether. Stomach-ache and faint- 
ings; aggravation in a warm room and by much exercise, and 
better in the open air. Leucorrhoea of a thick mucus resem- 
bling cream. Sometimes acrid, producing burning pain, some- 
times bland, most profuse after menstruation." 

Many aggravations of Pulsatilla are during menstruation. 
"Morning cough." — Fincke. 

Sepia. — Dr. Hitchman has reported a case cured by Sepia 
of much interest. 

Lady was set. 47, and a mother of several children ; had been 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 85 

confined to her bed some weeks, and for a long time her peri- 
odical secretion had not appeared until six weeks previous to 
the doctor's visit, when" she had a flooding period of five weeks, 
which, however, was arrested at time of being called. "On 
investigation found she had felt a pain in the left side, under 
the false ribs toward the back, of a cutting, digging nature; had a 
cough; no appetite, and was very weak and badly emaciated; 
suffered much with thirst and when she fell asleep perspired 
profusely. Subsequent explorations revealed a tumor tending 
to point at the spot where her pains had existed so long, and 
physical signs were that of air in the cavity and gurgling 
rales when coughing; at the end of ten days from first visit 
pure pus was expectorated and afterward the tumor was less 
pronounced. Various remedies were tried with only partial 
success until into March; China, Kali carb., Lycopodium, Stan- 
num, Pulsatilla among them." A few doses of Sepia at last 
cured the case almost magically the doctor says. It is not 
quite clear that tubercle played any part in this case, although 
the doctor speaks of a decided tubercular diathesis induced 
largely, as he thought, by mercury and other drugs, but there 
is no doubt about the pulmonary abscess, and the great danger 
to his patient from such abscess. The lady's courses became 
well established as her recovery was completed. The doctor 
mentions the symptom of cutting, bearing down pains in the 
abdomen extending to the thighs as connected with her flood- 
ing, which is the key-note to Sepia in this case. 

" On the sexual organs of women Sepia acts very distinctly. 
Along with cutting pains in the abdomen, a pressure is felt on 
the uterus downward, as if everything would fall out. The 
menses come too early (reverse of Pulsatilla), but are scanty. 
They are preceded by violent aching in the abdomen, causing 
even faintness, and by chilliness and shuddering. During 
menses drawing pains, palpitation and dyspnoea, toothache, 
headache and nosebleed. Frequent stitches in the vagina in 
paroxysms, with or without a watery yet lavish leucorrhcea. 
Leucorrhcea rarety acrid. Sepia produces (and cures) a dry 
fatigueing cough, provoked by a sensation in the region of the 
stomach as if cough come from there, or from the abdomen. 



86 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Again, it has a cough with copious, saltish expectoration, white 
or greyish-yellow. Stitches, faintness, nausea are accessory." 
— Dunham. 

We have hardly more than indicated the methods of study 
in this class of cases, not attempting in any sense to present a 
complete list of remedies which will be indicated, nor even a 
majority of such as will suggest themselves to any one as 
likely to be needed. Kreosotum, a remedy resembling in 
many ways Pulsatilla in its action upon the female organism, 
Conium, Iodium and Sulphur are remedies likely to be indi- 
cated as often as most of those receiving more extended notice, 
but their indications are not difficult to be found in our 
Materia Medicas when investigation is once directed in the 
right direction. Sulphur especially is a remedy to consult for 
many derangements of the female sexual system with a ten- 
dency to lead up into phthisical troubles. A few leading in- 
dications from Dunham will be a fitting close. " Menstruation 
appears to come too soon, and to be increased in quantity. 
Dry evening cough, colic, toothache and abdominal cramps 
often precede. Menstruation is likewise delayed or suspended, 
and this symptom, if accompanied by the night restlessness, 
constipation and other symptoms characteristic of Sulphur, af- 
fords a very valuable indication in practice. I have often used 
it successfully where menstruation was suppressed, whether 
by cold during a previous period, or by unknown causes and 
where Pulsatilla had been given without effect. I think it 
more frequently indicated in amenorrhoea than Pulsatilla." 



CHAPTER XII. 
HEMOPTYSIS: PULMONARY HEMORRHAGE. 

Many cases of consumption come to us with the antecedent 
of pulmonary hemorrhage; undoubtedly in many of these 
cases tubercle may be the cause of the hemorrhage, but prob- 
ably there are exceptions to this. Engorgement or congestion 
may exist and the pressure upon the walls be too great, when 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 87 

a hemoptysis will follow, no tubercle being present. But the 
congestion and subsequent inflammatory action may favor the 
exudation of tubercle, especially if there be a predisposition. 
Prof. Watson says: "The complaint of which hemoptysis is by 
far the most frequently symptomatic, is tubercular phthisis. 
There are many persons in whom the first attack precedes 
even for years the primary symptom of unequivocal phthisis; 
there are others in whom the first attack of hemoptysis is im- 
mediately followed by all the signs which announce the pres- 
ence of tubercle in the lungs. Many again do not spit blood 
until the tubercles have acquired considerable development 
and the phthisical symptoms have been for some time clearly 
marked." Audral says, of the persons whom he had known 
to die of phthisis, one in six never spit blood at all ; three in 
six did not spit blood until the existence of tubercles in the 
lungs was already made certain by unequivocal symptoms; in 
the other two-sixths, the hemorrhage preceded the other symp- 
toms of tubercular disease and seemed to mark the period of 
its commencement. This is a very large per cent., only one in 
six escape by this author's observation. Our observation does 
not give so high a per cent, however, but large enough to at- 
tach the gravest consequences to a hemoptysis; and yet we 
have learned to avoid usually fatal terminations following 
hemoptysis. M. Louis gives the ratio as four to six. As far 
back as the days of Cullen it was held that the spitting of 
blood was often the cause of pulmonary consumption. The 
significance of hemoptysis as bearing upon phthisis pulmona- 
lis is spoken of in the following manner by Thomas Watson 
in his London Lectures: "The occurrence of hemoptysis, con- 
sidered in reference to the probable duration of life in those 
who are subjects of it is of melancholy omen; if from any 
given number of persons who have been known to spit blood 
we subtract those in whom that symptom was connected with 
irregularity in the uterine functions " (and we need not sub- 
tract more than a fraction of these), " there will remain but 
few in whom the hemoptysis did not depend upon disease in- 
curable and progressive in its nature, of the lungs or of the 
heart; and if we further subtract those persons in whom the 



88 FHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

hemorrhage was symptomatic of cardiac disease, there will be 
very few indeed left in whose lungs the existence of tubercles 
may not be confidently predicted." 

TREATMENT OF HEMOPTYSIS. 

* 

The management of these cases is very important; for if the 
lung is left obstructed here, the seat of extravasation is likely 
to become the seat of tubercular deposit and a vomica; in cases 
preceding tubercularization with much arterial excitement, I 
have found Aconite a very serviceable remedy, especially if 
patient used wine or had been exposed to cold dry air ; Veratrum 
viride for removing congestions of the lungs, especially if we 
have heart complications, ranks very high. Elaps corallinus is 
also an excellent remedy; Plumbum aceticum is another. Of 
course the totality of symptoms must guide in this class of 
cases as everywhere else. Then upon Phosphorus, Lycopodium, 
Silicea and Sulphur, I have largely placed my dependence for 
the removal of later dangers from hemoptysis. I will report 
a case showing the results of this treatment. 

Anastasius Nicholas, of Greek extraction, set. about 40, had 
been subject to slight hemoptysis for several years; was small 
of stature, dark complexion, somewhat flattened antero-pos- 
teriorly about the thorax, and had but little energy physically. 
Was taken with a hemoptysis in the fall of 1870, while in New 
York ; case was very severe ; as soon as patient could be car- 
ried he went to his home in Vermont, where he was again 
taken almost as soon as he got home, and we were called; 
found him looking pale, covered with blood, and in great ap- 
prehension; gave reply to questions only by motions very 
cautiously made; blood was dark; pulse not accelerated, but 
rather slower than natural. Gave him Veratrum viride; no 
very active bleeding followed, but he had the taste of blood in 
his mouth, and a lacerated feeling about the heart; spitting up 
occasionally a little blood with indications and fear on pa- 
tient's part and my own that bleeding would return. Gave 
Elaps corallinus in place of Veratrum; all tendencies to hemor- 
rhage were controlled in the next twenty-four hours, and no 
bleeding has ever followed so far as we know; but we had in- 
flammation of the lung to control with Phosphorus, and later 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 89 

purulent expectoration and hectic fever to subdue with Lyco- 
podium. The case for weeks seemed one lingering along as 
tubercular phthisis, and we actually had a cavity of consider- 
able size open up in the right lung in the region of the third 
rib. We had as symptoms for the use of Lycopodium, hoarse- 
ness; feeble, husky voice, with irritation in the trachea; cough 
more loose in the day, and tightening up at night; sputum 
dirty, grayish-yellow and purulent; could not lie as well upon 
the left side, upper right side affected ; flushes of heat toward 
evening, and sour night sweats. Patient was apparently well 
in six months, and is still living. 

Aconite. — The power which Aconite is known to possess 
over the arterial circulation, leads us to think of it in our 
cases of active hemoptysis; and its influence upon the par va- 
gum, the principal regulator upon the heart's action, as well 
as modifier of the lung's movements, certainly does entitle the 
remedy to a rank of the very highest order for hemoptysis, 
especially when it results from over-distention and excitement 
of the arterioles, or the heart's disturbance; and in these points 
I think it will be admirably supported by Cactus. The blood 
is of a bright red color, foamy or filled with air-bubbles usu- 
ally; comes up easily from hemming or hawking, sometimes 
with a gush. There is much excitement and anxiety — often ap- 
prehension of death. The pulse is quick; there are stitches in 
the chest and palpitation among the accompanying symptoms. 
The hemoptysis is often brought on from using stimulants ; 
from exposure to cold, dry air and northwest winds. 

" Man, set. 35, has suffered for several years from cough, with 
scanty expectoration of mucus, frequently raising blood upon 
even slightly exerting himself; loss of flesh; has had for one 
week profuse hemoptysis; allopathic treatment with a bleed- 
ing; unsuccessful. 

Symptoms: — So weak that he can hardly speak or hold him- 
self up; paroxysms of coughing with raising of blood, come on 
often ; about every two hours ; he loses from one to two tea- 
cups full of bright red, foamy blood, preceded by the usual 
symptoms ; the face is pallid, surface of the body cool, pulse 
small, frequent, hard, from 100 to 110; stitches and feeling of 
7 



90 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

tension throughout the chest; breathing short; exhaled air 
hot; no appetite; much thirst; bowels normal; no sleep at 
night. Gave Aconite 24 , one drop every two hours. Oct. 20th, 
he feels better; the cough is better; has had no paroxysms 
since yesterday; expectoration still mixed with a little dark 
blood; feels stronger, freer in the chest; no more stitching 
pain; pulse fuller, soft, 80; sleeps. Gave Aconite 3 , every four 
hours. Oct. 21st, continued improvement; no trace of blood. 
Aconite 6 , one dose each day. On the 30th well ; the chronic 
cough removed by a few doses of Sulphur." — Hichelheim, 
Hygea, VII, p. 136. 

Arnica. — Arnica is especially adapted to hemorrhages of the 
lungs following mechanical injuries. The blood may be either 
black or of a bright red color; frothy blood mixed with mucus 
and coagula, is a form which Arnica sometimes controls. At 
times the stomach is disturbed, which seems to come from an 
irritation and tickling in the right lung. There is a periodi- 
cal flushing of heat which increases the action of the heart ; 
raw feeling in the chest; sore feeling when coughing. 

"A man, get. 62, of sanguine-bilious temperament, cured of 
the itch in his twentieth year with Sulphur. At no previous 
time suffering from any chest trouble, was suddenly taken with 
hemoptysis. On the day before, he had taken half a bottle of 
wine. S}rmptoms, during the last half hour: he has raised 
bright foamy blood (Aconite) mixed with clots and mucus, ac- 
companied with moderate vomiting, which seems to be caused 
by an irritating tickling in the right lung, near the insertion 
of the right bronchus into the trachea. He can breathe deep ; 
there is a periodical increase of heat and rush of blood into 
the chest, accompanied by increased action of the heart; the 
pulse is small, contracted, slow. The countenance looks pale; 
hands and feet are cold; occasional attacks of faintness. Pre- 
scribed Arnica 4 ; repeated on the second day. Soon after tak- 
ing the first dose all the symptoms disappeared, and he was 
discharged cured on the third day." — Trinks in Annalen der 
horn. Klinick, I, 286. Hempel and Arndt's, Mat. Med., Vol. I, 
p. 441. 

Belladonna. — The influence of Belladonna upon the blood- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 91 

vessels immediately arising from the great thoracic arch, 
would naturally lead one to think that it would have a deci- 
ded influence upon the circulation going on in the lungs ; it 
corresponds to a flushed face, excited carotids, irritation of the 
larynx or tickling in the trachea, pressure upon the chest above 
the epigastrium. Sometimes nausea which rises up into the 
throat. Perhaps burning heat in the chest, or heat beginning 
in the abdomen and rising suddenly up into the lungs and 
passing as suddenly away. Sticking pains may be felt in 
various parts of the chest. Sometimes there is the taste of 
blood in the mouth as in Hamamelis and Elaps. Skin is hot 
and considerable hyperesthesia in general. 

"A girl, set. 19, blooming, hearty, solid, was taken with a 
hemorrhage from the lungs after experiencing aches in the 
chest and hoarseness. Symptoms: sensation of pressure in 
the chest; anxiousness with simultaneous feeling of ascending 
warmth, greatly increased redness of the face, burning hot 
cheeks and forehead; tickling in the trachea, and expectora- 
tion of clear blood to the amount of a teacupful; cold hands 
and feet, small irregular, rapid pulse. Gave Belladonna 30 ; 
after thirty minutes quiet sleep, very little hacking, and that 
without expectoration ; relapse on the ninth day, met at once 
by Belladonna, and again five days later; to remove this ten- 
dency Natrum mur., Sulphur and Lycopodium were used. 
When I saw her four years later she was perfectly well." — 
Thorer, Arch., XIX, 3, 114. 

Cactus grand. — Cactus is indicated for hemoptysis with 
marked arterial excitement, though less than with Aconite, and 
when the heart is implicated. A squeezing, constrictive pain 
about the heart or scrobiculus is often felt; attacks of anxiety 
and threatened suffocation ; also sharp, wandering pains about 
the scapular region. Congestion of the chest which prevents 
lying down is not uncommon. Beating of the abdominal aorta 
may be felt. A sense as if an iron band prevented the normal 
motions of the chest may be found present. Spasmodic 
cough with copious mucus expectoration, or a cough with 
thick yellow sputa like boiled starch; such are the chief indi- 
cations for using Cactus; all the more strengthened if there 



92 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

should be a rheumatic complication with our hemoptysis. 
The palpitation of the heart so common where Cactus is indi- 
cated is worse by lying on the left side. Cactus patients are 
frequently spare, suffering from what is often called nervous 
consumption. 

Cinchona officinalis. — Cinchona seems well adapted to 
such persons as suffer from anaemia and passive congestions, 
to hemoptysis which shows a periodical tendency of returning 
every other day, or follows from loss of blood; also to patients 
who use alcoholics. " Singing in the ears and faint spells," Her- 
ing gives as an indication ; "rush of blood to the chest and head 
with excitement of the carotids" (Belladonna) is also given as 
indicating the use of Cinchona. " Craving of sour things in 
connection with hemorrhage," Hering gives as an accompany- 
ing symptom. Patients want the head high; are subject to 
sudden prostration ; troubled with stitches under the sternum 
and in left chest, which are worse during movements and deep 
inspirations (Bryonia), and also from slight touch. Cinchona 
has a clinical record for curing suppuration of the lungs fol- 
lowing hemoptysis, also for curing the phthisis of drunkards. 

"A woman, set. 40, has been nursing for six months her 
tenth child. She had formerly been perfectly well ; never had 
lung trouble. Has had cough with expectoration of blood for 
last two weeks. Symptoms: the woman seems strong, but 
always looks thin and miserable; nearly constant dry, hack- 
ing cough, with some pain in the chest every morning half 
an hour after rising, with constant tickling in the throat and 
some oppression of the chest; expectoration of bright red blood, 
about four ounces ; with it great exhaustion ; cannot stir; pulse 
small, thread-like, rapid, 100; appetite poor; bowels consti- 
pated for three days; mind apprehensive. Prescribed imme- 
diate weaning of the child, and two doses each day of China 12 . 
After the third dose the cough ceased, and she was well after 
receiving twelve doses." — Hichelheim, in Hygea, VII, 142. 

Digitalis. — Digitalis is often indicated in hemoptysis con- 
nected with tubercular infiltration and diseases of the heart. 
Distended veins, especially about the head; pale, livid face; 
coldness of the skin, with cold sweat and irregular pulse, are 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 93 

the usual accompaniments. Palpitation, or disturbance of the 
heart's action is also very common. 

It has been used successfully for pulmonary hemorrhage 
preceding menstruation, when pains in the chest, back and 
thighs have been associated: Heart disturbances usually ac- 
company Digitalis symptoms. 

Elaps corallinus. — Dr. Charge" speaks highly of Elaps co- 
rallinus in hemoptysis, and we have found it a very excellent 
remedy ourselves. The indications are expectoration of dark 
venous blood, almost black, though we have seen its beneficial 
effects in cases where the blood was not so dark ; there is the 
taste of blood in the mouth (Hamamelis) and a feeling of lacera- 
tion in the region of the heart. It would seem to be best 
adapted to the venous variety of hemoptysis as is Hamamelis 
and Veratrum viride. It seems to impress the heart with its 
influence somewhat as does Cactus, though Cactus has the 
squeezing sensation rather than the lacerated. 

Ferrum. — Has hemoptysis with bright colored blood (Aconite, 
Cactus, Ledum) and inter-scapular pains with slight cough. 
Patient has to sit up, and feels better when walking slowly 
about, though he feels too weak to keep erect. Is indicated 
when hemorrhage of the lungs follows arrest of the menses, or 
is connected with the debility that follows onanism ; also when 
following from removal of supporting walls to vessels where 
cavities exist, when the color is bright red. 

Hering mentions the symptoms, " feeling of soreness below 
the clavicle and under the left nipple." 

Paue says: "Quick motion and talking bring on cough; 
there is pain between the shoulders; face has a yellowish tint; 
sleep is poor at night, and there is frequent palpitation of the 
heart." 

Hamamelis. — Hamamelis has proved to have blood-staying 
action, upon the vessels of the lungs as well as those of the 
uterus and intestines, has arrested cases of hemoptysis occur- 
ring in connection with a tickling cough and where there was 
the taste of blood or Sulphur in the mouth. Tightness of the 
chest and a difficulty in keeping the recumbent posture (Fer- 
rum, Cinchona) have been accompan} T ing symptoms. Some- 



94 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

times frontal headache with a sense of constriction in the chest, 
the sense of constriction being increased by taking a long 
breath. Dr. W. E. Payne cured a case where the blood came 
into the mouth without any effort ; a teaspoonful or so every two 
minutes ; it seemed to issue in a warm current from below the 
right clavicle as patient represented the sensation ; there was 
also the sensation of a hard body in that region ; blood was of 
a venous character. 

Ipecacuanha. — The hemastatic properties of Ipecacuanha 
have been known for a long time. It would seem to correspond 
to both the inflammatory and spasmodic element. The hemor- 
rhage to which it seems to be best adapted is that which is 
aggravated by the least motion (Bryonia). The blood is of a 
light red color (Aconite, Ferrum, Ledum), nausea frequently 
being an associated symptom. Sometimes one hand is cold 
and the other hot. Morning expectorations of light red blood 
and mucus are among the clinical verifications, and often 
vomiting or retching has been associated. 

Kreosotum. — Its action seems to be upon the vegetative 
system of nerves and the venous vessels of the circulatory sys- 
tem, corresponding to a low grade of vitality, with a tendency 
of the secretions to rapid chemical degradation. Corrosive- , 
ness and fetor are likely to be characteristic of all glandular 
exudations to which Kreosote is applicable, and burning heat, 
a sensation apt to be felt at seat of disease. Complexion livid, 
possibly oedema of the feet and puffmess about the face; irrita- 
ble in disposition. The cough is whistling and dry, occurring 
more often in bed in the evening, accompanied with a crawling 
feeling below the larynx or in the upper bronchii. The hemop- 
tysis has usually been periodical, with pus-like sputa where 
our clinical records are of most value. For expectoration of 
black coagula it has also proved a remedy. Another form is 
blood-spitting, with severe pains in chest; with afternoon fever 
and morning sweat. It may be thought of in hemorrhages con- 
nected with abscesses secreting a foul purulent matter, where 
there is burning at the seat of the vomicae, or a craivling feeling 
in the upper respiratory tract. 

"A tailor suffered from periodical hemoptysis; was fever- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 95 

ish; could only lie on one side; had aches in the chest; yel- 
lowish-green purulent expectoration, and in fact every evi- 
dence of phthisis. For four successive days he received one 
dose per diem of Kreosotum, four drops on sugar. The bleed- 
ing ceased after the first dose and patient got well." — Arch., 
XVI, 2, 169. 

Ledum. — Many cases of hemoptysis which have called for 
Ledum, have occurred from troubles of the heart, as in Cactus, 
which it supports very well. Hemoptysis, alternating with 
rheumatism, finds a remedy not infrequently in Ledum. Con- 
gestion of the lungs, stitches in the chest, and soreness under 
the sternum are frequent accompaniments. Palpitation and 
pressure at left edge of the sternum is another sympton. Hem- 
orrhage at midnight and in the morning, occurring in connec- 
tion with a purulent fetid sputum has been found amenable to 
Ledum, the blood being bright red and foamy. A beating head- 
ache often accompanies or precedes hemoptysis. Hemoptysis 
is a pathogenetic symptom of Ledum, and Noack and Trink 
say it has a powerful action upon the lungs. Eruptions and 
tubercles on the face, and herpes on the body, which have been 
occasioned by its use, would indicate a very decided action 
upon the mucous membranes certainly. Then, we have small, 
red, constantly itching pimples on the chest with biting itching, 
from the provings. 

Ledum patients have hot hands and feet, as in Sulphur, par- 
ticularly in the evening ; they cannot bear the warmth of the 
bed for the heat of the limbs. Heat of the body has been 
found troublesome in patients afflicted with hemoptysis. 
Another symptom is, long-continued warm sweat on the hands 
and feet. 

" A young cachectic woman had cough with expectoration 
of blood. Symptoms: the attack which had formerly occurred 
on various occasions and had usually been cured under allo- 
pathic management in six to twelve weeks, came on from a 
violent excitement during catamenia. Very oppressed; rapid 
breathing; chest feeling as if pressed together; worse from 
motion or speaking; hard, hollow cough, jarring the chest and 
head, with expectoration of large amounts of clear, bright red 



96 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

blood, so that she had lost more than a pint. Terrible beating 
headache; bloated face, now congested, then pallid. Loud 
noises before the ears, with hardness of hearing; tickling in the 
trachea ; painful soreness below the sternum; feeling of fulness 
in the upper abdomen ; constipation ; oedema of legs and feet ; 
annoying drawing pains in the extremities whilst lying quiet ; 
feeling of heat all through the body, alternating with moder- 
ate perspiration; quick, full pulse; general lassitude. Gave 
Aconite, one dose. After nine hours Ledum pal. Bleeding 
ceased on the following day, and in three more days the pa- 
tient was performing her usual duties." — Veidel in Arch. XII, 
2, 145. 

" A young man was attacked with stitching pain in the right 
hip; later, the knee joints and joints of the feet began to swell ; 
some months subsequently and when the rheumatism had 
subsided, he was attacked with a fit of coughing followed by 
hemoptysis. The cough continued for weeks with an expecto- 
ration of thick, greenish, foul and fetid sputum. At this time 
there were evidences of a cavity in the left sub-clavicular re- 
gion. Various remedies were tried, and the hemoptysis oc- 
curred the second time. Patient sank rapidly with signs of a 
galloping phthisis. Four globules of Ledum 30 , given dry on 
the tongue. Prompt improvement followed, which was further 
forwarded by giving Ledum 200 ." — Dr. Stens, Sr. by Dr. Hoyne, 
in American Homceopath. 

Lycopodium. — Lycopodium like Sulphur seems to have a 
marked capabilit}^ for removing capillary congestion and a 
condition of overdistention in the arterioles. The cases in 
which we have had experience were marked with a very de- 
cided febrile action and with an afternoon aggravation. The 
fever has usually had the accompaniment of flushing heat ; 
sometimes there has been the sense of continuous pressure 
upon the chest very much like that of Phosphorus, which it 
further resembles in that patients are worse by lying on the 
left side. 

"Patient, set. 40, has been exposed to night air for years; 
suddenly roused from an afternoon nap by copious spitting of 
blood; checked by astringents after the loss of a half pint of 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 97 

blood. On July 20th, called and found him feverish, restless 
and weak. Gave Aconite 2 every two hours ; was called again 
in the evening, he having raised about a pint of blood ; the 
fever was much more severe and patient quite weak. Millefo- 
lium soon arrested the hemorrhage. Aconite and Millefolium 
then in alternation; later China 3 every two hours. July 21st, 
on examination the upper portion of both lungs disclosed a 
dullness on percussion with bronchial respiration and mucous 
rales; dullness mostly on left side, but more soreness on right 
side; constant hacking cough with bloody sputa. Ipecacuanha 
every two hours; frequent change of remedies with alarming 
symptoms steadily increasing. During September gave Arnica, 
Arsenicum, Kali c. and Lycopodium without relief. Oct. 1st, 
Calc. phos. by advice of counsel ; prognosis very unfavorable ; 
appetite poor, greatly emaciated; bright, glassy eyes; red spots 
on cheeks; severe hacking cough; profuse night sweats- 
worse at 4 p.m. Lycopodium given again with rapid improve- 
ment, which was continuous." — A. M. Cushing. 

Phosphorus. — Dr. Holcombe gives us from his provings of 
Phosphorus, " sensation of heat in the lungs ; disposition to take 
deep inspirations with discomfort in doing so; shooting pains in 
the right side of the chest; severe pain in the posterior part of 
the left lung, aggravated sometimes by inspiration and some- 
times not; tickling cough, fugitive thoracic pains." If the long 
narrow stool be present, it is an important characteristic. 
Wanting cold food, particularly milk, is characteristic. It has a 
fine clinical record for controlling hemoptysis coming on from 
tubercularization of the lungs; is best adapted to tall, slender 
and rapidly growing persons; the florid complexion and 
attenuated muscular development give the best type for 
Phosphorus. In cases of bleeding from an enfeebled circula- 
tion, as in fatty degeneration of the heart, Phosphorus again be- 
comes indicated. A valuable symptom is pressure upon the 
chest when coughing, or sticking pains at the epigastrium, creat- 
ing a desire to press the hand there for relief. The color of the 
blood is red as in Aconite, Cactus, Ferrum, and Ledum. The 
febrile symptoms are marked, and the nervous system much 
disturbed. 



98 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Ebullitions and congestions are marked in the provings of 
Phosphorus. Raue recommends it for profuse hemorrhages 
pouring out freely and thin, ceasing for a time. We have 
often given it for blood-spitting in phthisical patients of the 
florid complexion and of an excitable temperament, with satis- 
factory results. In one case we remember patient preferred 
cold food, and had a relish for cold milk in particular. Sudden 
general weakness is very characteristic of Phosphorus. The 
rough, raw, scraped sensation in the throat conjoined with 
similar sensations in the trachea and chest are emphasized by 
Dunham, as well as the stitches in the left side of the throat, going 
toward the ear and up to vertex. Hering gives, " cannot talk 
without pain in larynx." Lippe, "trembling of the whole 
body in coughing.'' Raue gives, "profuse hemorrhages, pour- 
ing out freely, then ceasing for some time." 

Phosphoric acid. — This remedy has much analogy to 
Phosphorus which we have just been considering; the same 
nervous irritability and congestions in the chest as indicated 
by the violent pain and oppression ; the tickling sensation ex- 
tending down to the epigastrium has other correspondence. 
Stomach symptoms are very common even to dyspepsia. 
Hering gives, "spasmodic tickling cough with expectoration 
of dark blood in the morning," but we incline to think the 
hemoptysis will usually be florid as in Phosphorus. It also 
has much correspondence to Cinchona and quite a little to Fer- 
rum, both of which have the symptom of florid blood. There 
is also a iveak feeling in the chest as in Stannum. The restlessness 
resembles Rhus tox. Weakness, restlessness, heat, but not averse to 
being covered as in Secale, tendency to faint after meals, from 
loss of blood and from emotions, added to the constitutional 
symptoms, will usually be a safe guide. The hemoptysis of 
onanists very frequently calls for Phosphoric acid. 

" H., set. 20, has for years been troubled with cough followed 
by spitting of blood, with violent pains in lungs and dyspepsia ; 
no improvement after three months of allopathic treatment. 
Symptoms : a large amount of bright red foamy blood is ex- 
pectorated after previous hawking, accompanied with a sensation 
of fulness, great internal restlessness so that he does not know what 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 99 

to do with himself and with tickling cough; there are also 
stitches in the chest, especially when taking breath, drawing 
pains in the small of the back, loss of appetite, constipation 
and great pallor of face. Aconite 2 and later Arnica 6 produced 
merely a temporary improvement; the bleeding ceased en- 
tirely after Phosphoric acid 3 ." — Heffendahl in Allg. Horn. 
Zeitg., IX, 24 J. 

Plumbum aceticum. — We have hemoptysis mentioned by 
Sund, and suppuration of the lungs by Richt, from Plumbum 
ac. Hering mentions a cough with expectoration of blood or 
pus after hemorrhage from the lungs; cough worse lying on 
the bach and after getting out of bed in the morning ; also re- 
commends it for a dry, hacking cough in tubercular constitu- 
tions, with pressive pains in the sciatic nerve. Constipation 
or diarrhoea are frequently present, more often constipation, 
with great inertia of the bowels. The sheep-dung stool is quite 
characteristic of Plumbum. The febrile symptoms are internal 
chill with external heat; heat with thirst, anxiety, redness of the 
face and sleepiness. 

Schlecher (Allg. Horn. Zeitg.) relates the case of a woman 
who presented all the physical signs of advanced consumption 
with the following symptoms: "Great emaciation, fever with 
nightly exacerbations, prostration, diarrhoea, good appetite, ca- 
chectic appearance, hectic flush, constant cough day and night, 
copious exjDectoration of chunks of greenish pus streaked with 
blood, sharp pains in the side. Bryonia only relieved the pain 
in the side; four doses daily of Plumbum ac. restored the 
patient to a fair degree of comfort." — Hempel and Arndfs Ma- 
teria Medica. 

"A man, set. 70, of a slender make, was attacked with a 
violent cough, discharge of a quantity of bright red, frothy 
blood, coldness of the extremities, chilliness followed by heat; 
irritated, hard, accelerated pulse, constipation, thirst; palpita- 
tion of the heart, undulating feeling of malaise and warmth in 
the chest, embarrassed feeling about the head. The patient 
was promptly cured with a few doses of the acetate of lead." — 
Hempel and Arndt's Materia Medica. 

Rhus toxicodendron. — Like Arnica, Rhus tox. seems to 



100 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

have a power to restore the tone of tissues strained or over- 
worked. The cases of hemoptysis where it has proved most 
serviceable, are those which have followed strains, and over- 
exertion of the chest organs from blowing upon wind instru- 
ments. The blood is florid in color and is apt to be renewed 
from the least mental excitement. — Usually a pain in the lower 
chest is felt in connection with the hemoptysis ; there is a va- 
riety of hemoptysis associated with a tearing cough and purulent 
expectoration where clotted brown blood has come up from the 
bronchii; the cough is worse from evening to midnight, be- 
ginning perhaps at about 7 o'clock, the periodical febrile period 
of Rhus toxicodendron. Soreness and stiffness of the muscles, 
especially of the nape ; restlessness, relish for cold milk as in 
Phosphorus, are frequent accompaniments. Burt gives, " bloody 
sputa raised with great difficulty, with high fever." "Worse at 
night, particularly after midnight," Guernsey. Dunham em- 
phasizes, " constriction of the chest; short, anxious respiration; 
stitching pains in the sides and the hypostatic congestion." 

Sanguinaria Canadensis. — This remedy resembles more 
closely than almost any other the active inflammatory symp- 
toms attending tuberculosis of the lungs; and it has been used 
with success in arresting hemoptysis occurring from tuber- 
cular irritation. Flushes of heat, soreness and burning in the 
lungs, stitclies in the chest going to right shoulder blade, nausea or 
tickling at the stomach which causes coughing, flying heat from the 
head io the stomach, quick, small pulse and palpitation of the 
heart are guiding symptoms. Passages of flatus connected with 
the cough or disturbance of the stomach would support the other 
symptoms and strengthen our reasons for selecting Sangui- 
naria. Circumscribed redness of the cheeks in the afternoon } 
fever from 2 to 3 P. M. daily, is very suggestive of the blood- 
root. It is more often called for when hemoptysis sets in dur- 
ing the progress of phthisis pulmonalis. 

Secale cornutum. — Guernsey recommends Secale for pas- 
sive hemorrhages in scrawny cachectic subjects; in conditions 
where the corpuscles have a tendency to break down lacking 
fibrin; especially, for weakness attending, which does not 
come on from previous loss of fluids. (Opposite of Cinchona.) 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 101 

The hemorrhage to which Ergot corresponds, gets worse from 
motion (Ipecacuanha, Bryonia), its special action is upon the 
uterus, but it has proved of service in both hematamesis and 
hemoptysis. It has a very decided action upon the spinal 
system of nerves, in consequence of which we often get loss of 
muscular action ; exhaustion may be accompanied with sink- 
ing spells more often at about 3 o'clock a.m. Patients dislike to be 
covered even when the skin feels very cold ; pulse, thread-like and 
small. 

Sepia. — Mrs. W., set. 50, of a sanguine-nervous temperament, 
tall and spare, of scrofulous habit. A son and daughter have 
died of pulmonary consumption, and scrofula shows in her 
grandchildren. Taken with hemoptysis. Local physician re- 
fused to take charge of the case for the reason that he con- 
sidered it a case of consumption. We found her much pros- 
trated with pain in the forehead, dyspnoea, slow pulse and cold 
extremities. Learned that extremities had been inclined to be 
cold for weeks; urine very offensive; thick and dark; a sedi- 
ment in commode of a clay-colored substance. From the 
slowness of the pulse and imperfect circulation we were in- 
clined to think there was a rheumatic complication, although 
there was no pain except in the head. Gave Sulphur 30 , fol- 
lowed by Benzoic acid ; soreness and slight swelling of ankle 
joints in the course of three days, with relief of head and 
chest symptoms. Urine still of the same character; much 
prostrated by fever and a want of natural warmth of the*body ; 
so weak she has to be lifted from the bed; a hacking cough, 
which is worse from lying on the left side (Phosphorus); 
brownish spots about the bridge of the nose; forehead and face 
look as if inclined to freckle. Sepia 200 cured the case, so that 
she remained well for a few years, though we think she died 
later with consumption. 

Stannum. — Stannum has been given for hemoptysis where 
there was copious expectoration and the feeling of excessive 
weakness in the chest, so characteristic of the drug. There has 
been an oppressed feeling aggravated when lying down in the 
evening and also from motion. Soreness and stitches in the 
chest are noticeable symptoms. The fever is more marked 



102 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

from 4 to 5 p.m., as in Lycopodium ; that is, in the hands (Le- 
dum, Sanguinaria, Sulphur), especially in the evening; and 
then we have anxious heat as if perspiration was about to oc- 
cur. The feeling of weakness is often felt also at the pit of the 
stomach; all gone feeling it is called. The symptoms of Stan- 
num frequently increase and decrease in a sort of crescendo di- 
minuendo. 

A few additional remedies we have found to be of service 
in hemoptysis, among which are Carbo veg., Veratrum vir. 
and Sulphur. The well-known hem astatic powers of Carbo 
veg. in epistaxis have led me to try it also in hemorrhage 
from the lungs, and we fancy with very good results. In one 
case where it was tried there was a sense of constriction accom- 
panied with burning. (Sanguinaria.) 

We have given Sulphur more frequently as a support to 
Cactus, Phosphorus or some other remedy, than alone; and 
yet it is not lacking in power to control capillary congestions 
and excitements, out of which a hemoptysis often arises. It 
proves curative to an expectoration of dark blood with stitches 
in the chest, particularly extending to left scapular. (Right, 
Sanguinaria.) There is a feeling of weakness in the chest, but 
not so pronounced as in Stannum. Heat in the vertex and hot 
palms and soles are other indications. In conclusion, let me 
add, that there are many other remedies which will be found 
to be adapted to our cases of hemoptysis. The similimum of 
the whole case is the remedy of all others to take precedence. 
Veratrum vir. has been used by us somewhat empirically in 
cases of hemoptysis, but is of too much suggestive value to be 
here omitted. No remedy has a more profound action upon 
those nerves which supply the capillary vessels of the lungs, if 
we may judge from the intense congestion it is able to pro- 
duce. Acting upon this fact, we have given the remedy, and 
to our satisfaction. The burning pain in the region of the 
heart, faint feeling at the stomach, accompanied with nausea 
and the slow intermitting pulse, may be taken as good indica- 
tions when they exist. The space we have taken to present 
the leading remedies for hemoptysis, will need no apology 
when we remember how many cases of phthisis pulmonalis 
come to us beginning with a hemorrhage from the lungs. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 103 

CHAPTER XIII. 

CATARRHAL PHTHISIS. 

The importance attached to bronchial inflammations by Ger- 
man and French physicians, gives special prominence to ca- 
tarrhal affections as bearing upon phthisis pulmonalis. If 
mucous casts block the alveoli, or more exactly, catarrhal mu- 
cous cells and fibro-plastic nuclei mix together and fill the 
alveoli, giving us the condensation which so often ends fatally 
in the form of a phthisis, how very carefully should we watch 
our catarrhal affections. There can be no doubt about hyper- 
trophy of the mucous membranes following a protracted in- 
flammation. That pressure upon the vessels in consequence 
of the hyperplasia, may to a large extent cut off nutrition; that 
even the inflammation may extend to the fibrous structure 
thickening the parent tissue, is not difficult to see. Lastly, 
that from such a beginning all the graver evils attending cas- 
eous degeneration and tubercle may follow. 

We accept, then, the statement of that class of pathologists 
who believe that quite a per cent, of our chronic catarrhs 
finally terminate in caseous exudation and end in destructive 
wastes of the tubercular passages and the lung tissue proper, 
as a final result. Some die of chronic laryngitis before pro- 
gressive disintegration reaches lung tissue; others of bronchial 
ulcerations and dilatations, which become pus receptacles. 
The disease is comparatively slow, and, as a rule, not pri- 
marily of the tubercular diathesis, and is much more amena- 
ble to remedies; indeed, should almost without exception be 
arrested short of a fatal termination, if attended to in season. 

The greater the tendency to tubercle, however, the greater 
our difficulties. For the mucous membrane as well as the 
parenchymatous structure of the lungs is liable to tubercular 
exudation, though perhaps not as liable. In the progress of a 
catarrhal consumption, we have ulcers disintegrating portions 
of the larynx; trachea, bronchi, and, as a rule, the lungs will 
become implicated, revealing caseous products and cavities as 
a later accompaniment; the last appearing after the vital 



104 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

forces are pretty nearly undermined. The pressure that fol- 
lows from the hypertrophied mucous membranes prevents free 
ingress of air to the air-cells in the apices, and they load down 
with the cheesy deposit, carrying disease also to the parent tis- 
sue. Catarrh may be found wherever the mucous membrane 
is found, and we may find it changing its seat of action from 
one locality to another, just as we see rheumatism and many 
of the skin diseases shifting from one locality to another; 
always, however, adhering to the same kind of structure. 

Skin diseases, especially, tend to migrate to the mucous 
membranes, and are often the real cause of a catarrh itself. 
And then, again, the appearance of certain skin diseases are 
an indication that a diathesis exists, which may become the 
soil out of which tubercle sprouts. Such condition warns of 
danger and demands proper remedial measures. 

A catarrh of the stomach may be the leading step to defec- 
tive nutrition and imperfect assimilation, favoring the later 
step of arrest in vitalization and lead to tubercular exudation. 
The study of these points will lead to better treatment of our 
cases. 

Properly indicated remedies such as Argentum, Calcarea 
carb., Calcarea phosph., Carb. veg., Natrum sul., or mur., Lyco- 
podium, Nux vom., and Sulphur, should be early administered. 
Catarrhal affections of the vaginal passages and uterine cavity, 
again, are the sources from which are transplanted nasal and 
tracheo-bronchial catarrhs, which later may end in caseous 
exudation in the apices. We have seen two such cases die in 
a colleague's hands within a year. By no means should these 
be neglected. 

Again, too severe condemnation cannot be made of the prac- 
tice of using such local measures as tend to suppress the local 
expression when upon the utero-vaginal membranes, sending 
it to more vital localites in the organic scale. 

Alumina, Calcarea carb., Kali carb., Kreosotum, Lachesis, 
Lycopodium, Pulsatilla, Sepia, Sulphur and Thuja, are agents 
at hand, together with others, which if carefully selected will 
eradicate all danger from this source. Some of these remedies 
we have noticed in considerable detail in previous pages of 
this work. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 105 

Returning to the respiratory organs, we may begin with a 
nasal catarrh, where we find more frequently the anterior 
nares, and the irregular cavities called the nasal fossse, into 
which they lead, the starting point. 

The mucous membrane is here most exposed ; perhaps the 
posterior nares at this step become involved. Traveling 
downward we have pharyngeal complications, and from the 
naso-pharyngeal we have chronic laryngitis, and then tra- 
cheo-bronchial affections, all growing out of the primary seat 
of the disease by continuity of similar structure. We do 
not say that this is always the case, for a catarrh coming on 
from retrocession of any skin disease, or from a metastasis 
from the uterus or alimentary canal, may seize upon any of 
these points, and there develop the force of its morbific action. 
Right here let it be remarked that the nasal douche is often 
responsible for a catarrh of the bronchi, because the remedies 
only suppress and do not cure. As so many cases of consump- 
tion have a beginning in catarrhs, or are allied with catarrhs, 
we feel justified in giving in this place a comprehensive digest 
of treatment, with clinical cases to verify. A complete treatise 
upon consumption should in our judgment include to some 
extent the treatment of catarrh and pneumonitis, as well as 
hemoptysis. The law of metastasis is well illustrated as well as 
a clinical indication made by the following case from Knorre. 

" A girl, aet. 18, was afflicted every winter with a moist erup- 
tion upon both hips; when it disappeared she had catarrhal 
inflammation of the septum and alas on the inside ; discharge 
of a thinish mucus which was acrid, excoriating the upper 
lip and obstructing the nostrils. Scabs were apt to be yellow- 
ish-hued. There was a burning sensation aggravated by sneez- 
ing or blowing the nose and by touching it; was worse also in 
the morning. Patient had a pale, sallow countenance; was 
cured by Magnesia mur.V 

To this I will add a case of my own cured by Acidum nitr. 
A Mr. Kendall was troubled with an eruption about the anus 
which seemed to belong to the family of eczema. It annoyed 
him exceedingly from itching; there was an exfoliation of 
thin scales and a moist serous exudation. When the humor 



106 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

disappeared a hoarse bronchial attack came on attended by a 
violent cough, mostly dry, accompanied with sharp, sticking 
pains in the throat-pit. At times hoarseness amounted almost 
to aphonia. Acidum nitr. 3 cured the whole difficulty in a 
little while, the eczema not returning. I remember a fine 
record in treating a case of the catarrhal variety of phthisis 
with caseous exudation into the apices made with Causticum 200 . 
Patient was an elderly lady approaching 60 years. Counte- 
nance was a pale earthy, or dull chalky color. Had been trou- 
bled a long time with a cough and general catarrhal symptoms ; 
voice was nasal and husky; flesh was soft and flabby; easily 
put out of breath from exercise, and but little muscular en- 
durance. Patient was attacked with a severe cold which so 
prostrated her that she went to bed with considerable fever, 
followed by an intense aggravation of all the tracheal and 
thoracic symptoms; muco-purulent expectoration followed, of 
a very heavy character and only a shade more yellow than 
cream, appearing to the eye somewhat as cream does, only a 
little more dense; indeed, it was very firm and compact. The 
sputum was very abundant and came up in detached masses 
after severe coughing spells. Throat and chest were sore 
when coughing. Patient was sad and of complaining mood, 
almost beside herself; said she would drown herself, for she 
would not spit herself to death; very much out of humor; 
easily vexed and irritable. She recovered from her acute at- 
tack in two weeks with Causticum, and even advanced far be- 
yond her previous condition. 

I am fully assured that this case had a complication of 
tubercle or caseous exudation. Patient died three or four 
years later with consumption in the hands of another. It is 
now my opinion that Causticum could have been made to do 
much more for the case by using the higher attenuations at 
long intervals. As it was, I got my patient off my hands in a 
fairly creditable manner, and when three years later she came 
to want a physician, she went to another party to show her 
gratitude, and easily got her passport without being obliged to 
take herself off at her own hands. 

Catarrhal consumption may be divided into three stages: 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 107 

First, catarrhal, with thickening of the mucous membrane 
and pressure upon air-cells and subjacent tissue; second, with 
caseous exudation as a complication, and third, with softening 
and disintegration of caseous matter carrying down surround- 
ing tissue. These different stages should be carefully studied 
and promptly met with appropriate treatment. The first is 
easily cured, the last is very difficult. 

THERAPEUTICAL INDICATIONS AND CLINICAL 
VERIFICATIONS. 

Alumina. — Well adapted to catarrhs engrafted upon an 
anaemic state of the system and with constipation associated. 
Such persons often have perverted tastes, wanting charcoal, 
chalk, cloves, or other indigestible things. Perhaps they have 
been afflicted with tetter or other variety of skin disease. The 
catarrh often begins in the ears where there is to be found ul- 
ceration of the mucous membranes. Scurfs are perhaps found 
in the nose, the septum is swollen, the root of the nose tender; 
redness about the nose is a frequent accompaniment. As the 
catarrh progresses downward we have huskiness of the voice, 
mucus accumulates in the throat, dropping down from the 
posterior nares, or a tough secretion is thrown out from the 
laryngeal follicles difficult to be raised because of its adherence. 
The cough is aggravated by talking or singing, by eating such 
things as pepper, salt and vinegar, and by cold air; cough 
worse in the morning. Catarrh apt to be worse on alternate 
days. Alumina patients take cold on the slightest exposure 
(Hep. Calc), though they feel better in the open air. They 
cough a long time before they are able to raise; sometimes a 
sensation as if a loose piece of skin were in the trachea. 

Clinical. — " Miss L. P., set. 17, dark complexion, excitable 
temperament and of a phthisical family, had cough for three 
weeks, particularly violent in the morning, raises a little after 
coughing a long time, has also a cough in the evening. 

Alumina lm , two doses cured." — C. Wesselhceft. 

"A lady, set. 33, had for fourteen years a peculiar cough 
from an irritation in the throat as of a loose piece of skin; diffi- 
cult expectoration of putrid-tasting mucus; shooting pains in 



108 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

the spleen. Symptoms aggravated by cold air out of doors, and 
from getting tired by talking ; she is better in warm air ; pep- 
per, wine, salt and vinegar set her to coughing; cannot lie on 
the right side on account of her cough; riding gives her pain 
in the chest. 

Alumina 200 cured her after trying other remedies to no pur- 
pose." — BCENNINGHAUSEN. 

Mr. S. W., set. 37, of a spare habit, dark complexion, active, 
amiable, has to exert his voice every day in teaching music ; 
has had a constant cough now more than three years ; two 
attacks of lung fever in the time ; talking and singing makes 
him cough, but has a more decided aggravation at about 6 
o'clock in the morning. Coughs severely for a long time when a 
little sputum is thrown off; coughs some at night ; is short of 
breath when walking; is hoarse and feels a tension about the 
upper part of the chest. 

Cured by Alumina 200 . 

Ammonium muriaticum. — Is applicable where one has to 
clear the throat frequently, expectorating a little dense mucus 
which leaves a roughness and sore feeling behind the uvula, to 
a violent cough in the evening, causing the mouth to fill with 
water. Hemoptysis accompanied with itching in the larynx. 
Pressure and stitches in chest as if a morsel of food had lodged 
behind the sternum. Burnings are felt in small spots in the chest. 
Cough is dry and tickling, annoying both night and day. 

Antimonium crudum. — Epigastric and abdominal symp- 
toms are usually associated with the pulmonary in Antimo- 
nium crudum. Cough is accompanied with gagging or seems 
to come from the abdomen. Diarrhoea is a frequent accompani- 
ment. The voice is rough, feeble, talks or sings in a low and 
weak tone. Perhaps loses the voice on becoming heated; coughs 
worse on looking at the fire and in the hot sun, on coming into a 
warm room from the cold air. Cough is convulsive, the first turn 
being the most violent; raises a viscid thin phlegm deep out 
of the chest in the morning; cough shakes the whole body, with 
involuntary micturition. A symptom of importance if present 
is violent itching of the chest with pimply eruptions, or fine red 
dots as if a rash were appearing. 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 109 

E. J. B., set. 35, works as a stone-cutter; of a lymphatic 
temperament; has been coughing for several months; has be- 
come badly emaciated because of a protracted diarrhoea of a 
watery undigested character associated with his cough ; often 
gags and vomits when he coughs; stomach weak and tender to 
pressure and a great deal of pyrosis; tongue coated white; 
coughs by fits, the first turn being the most violent; is low-spirited 
and almost despairs of being cured of his pulmonary troubles. 

Gave Antimonium crudum 6 ; soon was much improved and 
made a good recovery; died a few years later of hydrothorax, 
the result of some trouble of the heart. At the time of our 
treatment of the lung and stomach troubles, patient had every 
appearance of dying in a short time with phthisis ; he was of 
a decidedly scrofulous habit. — G. N. B. 

Arsenicum iodatum. — Is adapted to catarrhs developing 
in malarial localities and in scrofulous constitutions, where 
we have enlarged glands and tonsils, puffy lids, a pale face — 
the hydrogenoid type of constitution as Grauvogl terms it; 
where there is weak stomach and defective assimilation, often- 
times the leading step to tubercular deposit. There are apt 
to be burning sensations in the nostrils and throat; patients feel 
the cold and are inclined to chilliness same as in Arsenicum 
cases. From its power to clear the glands from accumulations 
of hydro-carbonaceous matter and arrest hyperplasia, it would 
seem to be a good remedy for such forms of catarrh as often 
end in condensation of the apices ; possibly may be depended 
upon to remove the caseous exudation itself. It is a remedy 
not as yet well tested, but deserves our study and a trial where 
indications seem to warrant. . 

"H. B., boy, set. 16, dark hair and complexion, fleshy, but 
small for his age, had suffered with catarrh for four years; 
eyelids puffy; had always lived in malarial region and suffered 
with chills every year; nasal catarrh attended with a jelly-like 
discharge, though sometimes with a copious watery discharge, 
more often in the morning or after meals; the fauces were in a 
state of subacute inflammation and the tonsils enlarged. 
Iodide of arsenic in the 3d trit. cured the case." — Morse. 

There is much agreement in this remedy to Kali hydrojodi- 
cum with which it may be compared. 



110 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Bromium. — Bromium seems to act ver}*- decidedly upon the 
respiratory passages, and especially upon the larynx. It 
seems also to be well adapted to affections which begin in the 
bronchi and travel up to the larynx, the focal centre of the action 
of Bromium. Sharp pains in the thorax in cases of phthisis 
which have an ascending direction suggest Bromium. Its action 
upon the right lung is more pronounced, and it has been found 
a valuable remedy in hepatization of the lower lobes, the right 
more especially. Some pains about the clavicle lead us to sus- 
pect that it will be found a good remedy in catarrh with threat- 
ening of cheesy exudation into the apices, more especially of 
the left lung. Such pains as tearing in left clavicle; pressure 
below the left clavicle; cannot lie upon the left side (Phos., 
Lycop.); paralytic drawing pain through left chest toward the 
scapula and into left arm; sensation of weakness and exhaus- 
tion in the chest. The more marked action of Bromium upon 
the right lung in general, and the apices of the left in particu- 
lar, would indicate that the remedy acted obliquely through 
the thorax and upward to the larynx. Respirations are short 
and cough paroxysmal; also cough is long-continued; sounds 
loose, but little or no expectoration; cough is aggravated by 
exercise and on entering a warm room; voice husky, hoarse, 
may have aphonia ; deep, forcible respirations become neces- 
sary at times; cough excited by deep inspiration; scraping 
and rawness in larfnx, and by tickling in larynx; larynx 
painful to touch. 

" A robust, blooming young man, set. 20, took a violent cold. 
For six weeks was not able to speak loud ; absolute aphonia 
in the morning, but can talk in a whisper after expectorating 
under long-continued coughing (Alum.) a little phlegm. There 
is present a frequent and exhausting cough, with expectora- 
tion of white, whitish-yellow or yellow matter slightly soluble 
in water; during the last few days expectoration of clear, dark, 
coagulated blood ; constant feeling of soreness in the region 
of the hyoid bone. Cough is aggravated by inhaling dust or 
cold air. Cured in a short time by Bromium 3 , three times per 
day." 

Calcarea carbonica. — Ranks very high among our reme- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. Ill 

dies for curing chronic catarrh, especially catarrhs engrafted 
upon the scrofulous type of constitution with tubercular ten- 
dencies. Faults of second assimilation belong to this class of 
patients to which Calcarea c. has long proved so effective. Such 
persons are very susceptible to external influences, such as 
currents of air, cold (Alumina), heat, noise and excitement. The 
least cold seems to go through and through, one is so sensitive. 
The flesh is soft, the body inclined to fleshiness; the glands to 
enlargement. Patients perspire easily, especially on the head 
(Sil.), and on the feet, which are often so damp as to wet the 
stockings. May sweat on the limbs from the least exercise an<i 
on first going to bed. Patients complain of dryness of the 
throat and of a tough secretion hard to be detached, not abundant 
or stringy as in Kali bichromicum. Feels as if feather doivn 
was in the throat, which provokes a cough. Cough often shakes 
the head and may provoke vomiting because of .the adhesive- 
ness of the mucus; cough usually dry at first, especially at 
night, terminating with a profuse saltish expectoration or pos- 
sibly a sputum with a sweetish taste. Chronic and painful 
hoarseness is often associated with the catarrh to which Calca- 
rea c. is so well adapted. Patients are easily out of breath, 
especially on going up-stairs; dislike the morning air and 
shudder as twilight approaches; milk disagrees, while there is a 
craving for eggs, as in Pulsatilla. Sometimes there is a swell- 
ing over the pit of the stomach, size of a saucer; feet feel as if 
one had on damp stockings; are slow to become warm in bed. 
Patients inclined to dizziness in the head and wakefulness 
after 3 o'clock a.m. In the chest we have uneasiness and ach- 
ing pains, sometimes stitches, but they are not worse from breath- 
ing, as with Bryonia. There is also an oppression which is 
relieved by throwing the shoulders back. A very important symp- 
tom is soreness of the chest, and particularly under the clavicles, 
felt both at respiration and from pressure given by the hand. This 
tenderness to the touch gives a suspiciousness of cheesy exu- 
dation when found associated with catarrh, and this symptom 
of Calcarea c. gives us a leading indication for its use. If we 
have too early and copious menstruation associated with our 
catarrh, or catarrh with condensation of the apices, with any 



112 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

corroborating symptoms, it would be a strong hint for its use. 
Then, again, if we should have the diarrhoea so characteristic 
of Calcarea c, thin, white, undigested in character, sour of smell, 
aggravated by milk and attended with a faint feeling, and fol- 
lowed by great lassitude, we would have our picture complete; 
but we will rarely get more than a part of our Calcarea symp- 
toms in any one case; nor need we, to be sure of benefiting 
our patient. 

"Mrs. T., set. about 53, a widow, of the sanguine nervous 
temperament, has had sixteen children, nine dead; has had a 
bronchial disease of five year's standing; began with catarrh 
in the head which traveled down; severe anorexia; lives 
mostly on milk and takes barely enough to support life; is too 
feeble to be up; has rheumatic complication added to her 
bronchial consumption, which increases her wretchedness. She 
is chilly on the back if she attempts to rise; throat is sore in 
the evening with subsequent fever without thirst; suffers with 
most intense heat and shortness of breath ; heat comes with dis- 
tressing flushes; is sleepless; coughs severely. Calcarea c. 200 
cured." — J. H. P. Frost. 

"A laborer, set. 38, intemperate, many years afflicted with a 
cough, expectorating mucus and pus ; perspires freely during 
the night; countenance haggard and worn; chest covered with 
pustules for which Sulphur was given producing much aggra- 
vation of cough and expectoration, while eruption also came 
out over the body generally. Prescribed Calc. c. with immedi- 
ate abatement of pulmonary symptoms, and patient went to 
work a year later cured of both cough and the eruption." — 
Hitchman. 

Dr. H. N. Guernsey says in cases where "abscesses form in 
the lungs of young persons who are threatened with consump- 
tion," he gives Calcarea carb. lm after the pus is discharged and 
a complete cure is the result; the expectoration has often a 
putrid odor." 

"A man, ret. 46, slender, cachectic, when a child troubled 
with tinea capitis, guilty of sexual excesses; after taking cold 
six months since, dry cough, physical signs pointing to tuber- 
culosis; prominent symptoms are vertigo when going up 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 113 

stairs; dizziness and trembling before breakfast, headache; 
throbbing in the centre of the brain ; nostrils plugged up with 
yellow fetid scabs; swelling of the tonsils with constrictive 
sensation when swallowing; dislike of his accustomed pipe; 
sensitive condition of stomach and weakened digestion; nat- 
ural stool every four or five days; scanty, blood-red urine; 
tickling as from a feather in the throat which makes him hack 
during the day, but causes such violent dry cough in the night 
that it brings on violent beating of the heart and arteries; at 
times he vomits after it, has difficulty of breathing and upon 
deep inspiration violent stitches in the chest; uneasiness about 
the heart; swelling of the cervical glands; pain in the small of 
the back; constant and marked chilliness with great thirst; 
great exhaustion, lassitude and sleepiness during the day; at 
night profuse sweat on the chest which weakens him ex- 
tremely; with it an unusual general prostration and appre- 
hension concerning the state of his health. 

Prescribed Calc. carb. 30 ; after a week, symptoms of improve- 
ment, mind more cheerful, disappearance of sweats, tendency 
to cough decreased and the cough became less dry ; he contin- 
ued to improve until he considered himself well." — Translated 
by Dr. Arndt. 

Carbo vegetabilis. — The effect which Carbo veg. has upon 
the respiratory tract as well as the digestive organs and lym- 
phatic glands gives to it a wide range of applicability to our 
jDulmonary affections. It has a catarrhal range, assimilative 
range, a hemastatic power, and is a powerful eliminator of 
effete matters, and has also an antiseptic influence, hence may 
be adapted to recent and old catarrhs, bronchiectasis, hemop- 
tysis and to cheesy decompositions when passing into a putres- 
cent state. 

Indications : itching in the throat, hoarseness, rawness in 
the larynx ; worse evenings ; morning aphonia in damp cool 
weather; chronic hoarseness aggravated by wet weather, espe- 
cially wet evening air, and by talking; voice fails unless there is 
much exertion made to speak. Breath is short, with cold hands 
and feet; desires to be fanned and calls for more air; the body 
has hot flashes passing over it when coughing; cough is violent 



114 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

by spells with a profuse expectoration as in bronchiectasis: 
cough again is hollow and spasmodic ; worse in the evening 
or before midnight; dry and painful, or attended, it may be, 
with purulent, offensive slimy sputum. At times one feels as 
if cough was caused by vapors of sulphur ; has a choking sen- 
sation which is relieved by motion ; cough sometimes causes 
stitching pain in the head; is worse on going into a cold place 
from a warm room; from walking in the cold air, from lying 
down, from eating cold food and drinking cold drinks; sputum 
often tastes sour or saltish ; is of an unpleasant odor ; sputum 
of different shades; whitish and tenacious, with a good per cent, 
watery, brownish, bloody, yellow-green purulent; in the lungs 
a heat as of glowing coals is set up. 

Other and grave symptoms more properly given in another 
place. 

" A lady caught cold fourteen days ago, has coughed for a 
week; coughs worse by day and in the open air and during 
supper; cough is continuous, dry and hard, with soreness of the 
chest and heat of the body when coughing; sensation at night as 
if there was mucus in the throat choking her when she coughs; 
the choking is relieved when sitting up or on moving. There is 
itching in the throat, extending into the chest, which is worse when 
coughing. Carbo veg. cured the case." — E. W. Berridge. 

Kali carbonicum. — Suitable to anaemic and hydremic con- 
stitutions. Puffiness of the eyelids and stitches are among the 
characteristic symptoms. There is mucus in the fauces which 
is only removed by constant hawking. Cough is worse about three 
o'clock in the morning. Eating and drinking aggravates the 
cough. Is troubled about lying upon the left side. Heart symp- 
toms apt to complicate the pulmonary symptoms. 

"Miss G. P., fair blonde, set. 20; much mucus in fauces 
which she is constantly obliged to remove by hawking; sharp 
stitches in the eye while reading or sewing. Kali carb., three 
doses daily, relieved the tedious affection very soon." — C. Wes- 

SELHOEFT. 

Kali hydrojodicum. — The iodides of potash and arsenicum 
both seem to be attracting considerable attention as curative 
agents in catarrhs. The action of iodine as well as potassa 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 115 

upon the respiratory tract would lead us to expect these re- 
sults gained at the bedside of our patients. The specific ac- 
tion also which Kali hyd. has to certain cachexias, such as 
scrofula and syphilis, adds to its pledge of usefulness in many 
cases which we shall meet in our practice. It may have more 
power to arrest the progress of syphilis than scrofula, more 
efficiency in removing the exudative product known as gum- 
mata than tubercle, but that it has an applicability to both 
constitutional states is admitted, and warrants us in testing 
the remedy much more thoroughly than has yet been done. 
And especially, in the potentized form, for acute catarrh and 
secondary pneumonia as well as catarrh, with cheesy exuda- 
tion and with syphilis. Among the indications for its use 
will be found the following symptoms : catarrhal voice; hoarse- 
ness with pain in chest ; oppression of breathing, ivith pain in 
both eyes; sometimes eyelids are swollen; awakens with a chok- 
ing sensation; can scarcely breathe; oedema of the larynx! 
rough feeling in the trachea, compelling hemming and hawk- 
ing; cough, with dry hawking; and later, expectoration of 
copious green sputum; abundant expectoration of white froth, 
resembling soap-suds; stitches from sternum through to the back 
(Kali bich.), or deep in the chest while walking; purulent sputum 
with exhausting night sweats ; loose stools ; oedema pulmonum 
accompanied with morbus Brightii. Morbus Brightii, Ben- 
nett says, frequently follows arrest of the degradation of 
tubercle in the lungs. 

" A. D. In consequence of a neglected cold, pneumonia fol- 
lowed with hepatization of right lung. Bryonia, Sulphur, 
Phosphorus, Rhus tox. and Bromium were tried to no purpose, 
when Kali hyd. was given and followed by rapid curative pro- 
gress. The most striking symptom being abundant expectora- 
tion of white froth, resembling soap-suds" — W. E. Payne. 

"P. R. P. After an attack of diphtheria had the following 
symptoms: paleface; sunken eyes surrounded by blue rings; 
expressionless countenance; oedema of the eyelids; deep hollow 
cough with whitish expectoration; great prostration; tearing 
pains in the limbs; loss of appetite; swelling of glands about 
the neck; constant thirst; copious micturition; sleeplessness; 



116 PHTHISIS PULMONALIS .'■ TUBERCULAR PHTHISIS. 

nightly aggravations. Pronounced hopeless by attending phy- 
sicians. Cured by Kali hyd." — Dr. D. F. Hunt. 

Lycopodium. — A very efficient remedy in controling affec- 
tions of the mucous membranes. It corresponds rather to the 
dry form of catarrh than the fluent. To persons inclined to 
emaciation and a weak peripheral circulation, it stands almost 
foremost among all our remedies. The emaciation is more 
noticeable in the upper 'portions of the body ; cold feet and hands 
are among the more noticeable symptoms belonging to Lyco- 
podium. The stomach and alimentary tract usually present 
important symptoms if Lycopodium be the remedy, flatulency 
being the most important. Patients sit down to their meals 
thinking ihej can eat heartily, but are quickly filled; feel full 
and pressed at the stomach ; food is apt to sour. Besides eructa- 
tions we have pressure in abdomen from flatus. Cough is dry, 
seeming to come from the stomach; is apt to be worse about 
4 o'clock p.m. or a little later; is usually induced by a tickliug 
sensation in the larynx; by lying upon the left side (Phos., 
Sepia) ; by eating and drinking cold things (Carbo veg.) ; by being 
in the wind, and from the air of a warm room ; voice is hoarse, 
husky and feeble, with the sense of dryness in the trachea; 
the kidneys are another foci of expression, and we have brick- 
dust deposit in the urine. Among the chest symptoms we find 
continuous pressure and a raw feeling internally ; stitches in the 
left side during inspiration. It has proved curative in cases of 
neglected pneumonia when purulent expectoration has fol- 
lowed hepatization, and in catarrhs which have continued un- 
til complicated with cheesy exudation into the apices. 

Dr. Pope says, "Few remedies are so valuable in pulmonary 
phthisis as this when persistently used." 

" A boy, set. 14 ; thin and weak ; but little muscular develop- 
ment; mind active and of a sensitive nature; mother died of 
consumption; has a hard, dry cough which is making him so 
feeble he can but with difficulty stand; coughs all day and 
night, even when asleep ; very violently in the morning ; res- 
pirations very rapid and a quick pulse; voracious appetite. 
Lycopodium 200 cured." — P. P. Wells. 

" A girl, est. 15; has always been delicate; had pleurisy three 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 117 

3 T ears ago; has also had sores on legs; healed now and since 
has been worse; father and one sister died of consumption; 
has pains shooting into right hypochondrium of long standing; 
has a cough and raises a yellow sputum; pains shoot from 
upper middle chest to back when coughing; short shiverings ; 
likes to be near the fire; faint when undressing; clammy sweat 
and feeling of coldness ; worse 4 and 5 p.m. ; fan-like motion of 
ali when feeling worst. Cured by Lycopodium." — Berridge. 

Mercurius corrosivus. — This and the proto-iodide are the 
forms of Mercury which we have used chiefly in plastic exu- 
dations. Mercurius cor. has a powerful influence in control- 
ing albuminous exudations and glandular engorgements. It, 
with Apium vir., is our remedy in morbus Brightii. In ca- 
tarrhs, nasal, bronchial, intestinal and uterine, we have found 
no remedy more frequently of service. The complications of 
pulmonary affections with albumen urea, so common in phthi- 
sis, will be better controlled by Mercurius cor. when the chronic 
stage is reached than any other remedy so far as our experi- 
ence goes. But we have always given the 200th dilution. The 
secretions of the mucous glands which indicate Mercurius are 
usually corrosive; patients are worse in damp weather; at night, 
especially in cold, damp night air. Their symptoms are aggra- 
vated by both cold and warm air, especially from getting warm 
in bed. Patients are also inclined to perspire; sweat starts out 
from the least exercise or from pain ; the sweating not affording 
any relief; the head often feels as if it would burst or was grow- 
ing larger. 

Patient is hot and cold in alternation; salivary glands become 
fluent ; gums have a whitish line running along the middle ; breath 
fetid; parotids tender; perspiration often sour (Lycopodium), 
comes out all over and suddenly, while Calcarea is more about 
the head and feet, as is also Silicea, both coming out more 
moderately. The cough is violent, often prevents one from 
speaking; at least every attempt to speak provokes a violent 
cough; head snaps; sometimes coughs till vomiting sets in; 
there is tightness across the chest; stitches in the chest, mostly 
in the lower right lobe. 

Mrs. L, set. 37, sanguine temperament, subject to severe 



118 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

attacks of catarrh, most troublesome in the spring; coughs 
worse in the evening, in cold, damp weather and after getting 
warm in bed; breaks out suddenly into a drenching perspira- 
tion from slight exercise; is easily out of breath from walk- 
ing; cough is provoked by any attempt to talk; is exceedingly 
harassing, so much so that a drenching perspiration follows 
the more prolonged attacks; troubled to hold her urine when 
coughing. Merc. 200 cured promptly and permanently. 

"B. R., eet. 8, of scrofulous diathesis, light complexion, had 
ozcena for ten months ; much emaciated ; swelling and redness 
of the nose ; nose stopped up ; scabs in nostrils ; loss of smell 
and taste; discharge from nose like glue; tonsils large ; all the 
symptoms are worse in the open air, especially damp, cold 
air ; is worse also at night. Gave Merc. cor. with a rapid re- 
covery." — Dr. D. F. Hunt. 

Mercurius proto-iodide. — This remedy seems to combine 
the properties of Iodine and Mercury. It is applicable to cer- 
tain phthisical cases which have a catarrhal and scrofulous 
origin. The same power which Mercury has shown in arrest- 
ing albuminous deposits is exhibited in arresting the vascular 
congestion so favorable to cheesy exudation. We have used it 
more frequenthy perhaps, for catarrh of the nasal passages, 
where the conjunctiva has sympathized, or even where there 
have been ulcers upon the cornea. The septum has been 
thickened, with soreness of the alas which are inclined to be 
covered with crusts ; plugs are discharged from the nose which 
are tinged with blood ; as the disease progresses downward the 
tonsils become inflamed and enlarged; then the larynx and 
trachea are attacked ; at this time we have hoarseness and loss 
of voice; next a cough which is loose, rattling, with the bronchi 
loaded with mucus as the catarrh travels onward, and the spu- 
tum becomes copious and yellow. Patient is sensitive to cold 
damp weather as in Mercury, and also worse in the spring. 
There is a tendency to empty deglutition; hawking to clear the 
throat of a lump ; perhaps gags while trying to clear the 
throat ; appetite is variable with weak empty feeling at the 
stomach ; sweats easily and suddenly as in Mercurius. 

In some cases when the throat, nasal and eye symptoms of 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 119 

a grave character have developed in constitutions where con- 
sumption was hereditary, I have witnessed the best of effects 
from this remedy. 

B. E., set. 5, dark hair and black eyes ; mother died of tu- 
bercular phthisis ; has been troubled with nasal catarrh for 
two years ; thick, hard plugs form in the nostrils, which so 
block the passages that he has to breathe through the mouth ; 
scales come off with the plugs, leaving the mucous membrane 
sore where pus-globules are seen on ulcerated surfaces. The 
voice has a thick, broken sound with much of the nasal twang. 
Tonsils are enlarged and respirations increased; snoring at 
night in sleep ; coughs at night and raises a quantity of mucus 
which comes up easily ; bridge of the nose swollen, the con- 
junctiva apt to be red, especially if case is aggravated by a 
cold. Vessels of the inner canthus of right side often throw- 
ing out distended and reddened lines to the border of cornea 
where an ulcer appears ; upper lip swells and glands of the 
neck are also inclined to swell. 

Mercurius proto-iodide 200 cured. — G. N. B. 

Nitric acid. — So generally has mercury been used for many 
years,' the constitutions of a large per cent, of our people have 
been injured either directly, or from the condition the germ 
has been found in, at the time the organic type has been prop- 
agated. This multiplies diseases both of the throat and lungs 
to which Nitric acid becomes appropriate. Besides we have 
troubles of the throat which simulate a catarrh, but have 
syphilitic complications. 

Such cases especially call for the use of Nitric acid. Both 
the syphilitic and mercurial dyscrasia favor the production of 
tubercle in that they degrade the blood and sap the vital forces. 
We have met with several cases of phthisis which were de- 
veloped out of syphilitic inoculation and mercury used to 
control it. We do not say but that syphilitic products are dif- 
ferent form tubercle pathologically, but we do say that we 
have seen syphilization and mercurialization end in a caseous 
exudation and cavities in the pulmonary tissue, which we 
believe would not have occurred only for such syphilization 
and mercurialization. There are also cases coming to us purely 



120 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

catarrhal, to which Nitric acid is appropriate. Some of the 
indications are coughing up a bitter or sour tasting sputum in 
the morning, followed by greenish-white casts as if from the air- 
cells; it is very common to have soreness of the larynx; a very 
important symptom, when present, is a sticking sensation behind 
the sternum, as if a sliver were caught there ; a strong ammoniacal 
odor to the urine is often present in Nitric acid cases; sometimes 
gastric troubles, such as nausea, which is better by riding in a 
carriage; itching and eruptions at the anus are often met with 
also. 

" A patient, set. 34, sandy complexion, blue eyes and excita- 
ble, of a scrofulous habit, intemperate, dissolute ; been under 
treatment for syphilis; called on me for ozcena; has an offen- 
sive yellow discharge from the nose ; redness of the nose and 
excessive sensitiveness to the touch; deep ulceration of the 
nasal mucous membrane and of the soft parts ; loss of portions 
of the septum. Redness in the posterior throat, which is cov- 
ered with a dirty green slime and ulcerated in spots; sticking 
pains in the nose and throat; sticking in the sternum; great 
weakness; restless at night; peevish, irritable, despondent; 
is troubled with constipation. Cured by Acidum nitr. 3 ." — 
Dr. Arndt. 

" Mr. L., set. 30, dark hair, light complexion, hardy constitu- 
tion, applied to me for treatment of an obstinate catarrh ; a 
year ago contracted a specific ulcer which after a time healed, 
but was followed by constitutional symptoms, painless swelling 
and induration of the glands, ulceration of the tonsils; the 
discharge from the nose was fetid, salty in taste and frequently 
copious ; upper portion of the nasal fossse and post-nasal cavity 
most affected ; mouth aphthous. Nitric acid cured in the 2d 
dil." — Morse. 

Mrs. C. E. H., set. 45, slender and delicate, with brown hair, 
blue eyes and sallow complexion, inclined to diarrhoea, to 
eruptions about the outlets of the body; excoriating leucorrhcea; 
ulceration in the mouth, particularly about the palate and 
fauces, extending even to the pharynx. The throat symptoms 
usually most pronounced. Nose a little sore, often discharging 
a corrosive yellowish matter. Green casts discharged from the 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 121 

nose usually in the morning. Sometimes patient is troubled 
about getting choked at the table from, bits of meat; throat is 
tender to touch, with raw feeling on swallowing ; prickings be- 
hind the sternum as if a sliver was there. Coughs a good deal ; 
cough mostly dry ; voice gets weak from talking. Slight dul- 
ness of the apices and flattening of supra-scapular spaces. 
Patient is making her menstrual climaxis. Mother died at 
this period of her life from phthisis. The above case was suc- 
cessfully managed with Nitric acid supported by Lachesis. — 
G. N. B. 

Stannum. — No remedy ranks higher for controlling old 
bronchial inflammations that have run on till the tubes have 
become thickened and narrowed in places and dilated in 
others. The old-fashioned consumption which ran on for 
many years till bronchiectasis with purulent and chemically 
degraded matters, poured from these pockets, has been more 
often cured by Stannum than any other remedy that we know 
of. It is also an efficient remedy when we have complications 
of the caseous degeneration into the apices. It does not corre- 
spond to that high grade of febrile excitement which usually 
attends Phosphorus and Sulphur cases, though we may have 
the pulse run up very high. Weakness of the chest is the most 
important and universal symptom ; tires out from the cough, 
and by talking, in the chest. Sometimes feels like dropping 
down almost helplessly into the chair. The second most notice- 
able symptom is, the very large amount secreted by the mucous 
membranes to be expectorated. The sputum is yellowish or 
yellowish-green with much glairy mucus holding the yellow 
part in its meshes; or it may be chiefly of the yellow cast and 
in heavy, distinct mouthfuls. At times we have a dry cough 
of a hacking, teasing nature which Stannum will cure. Pa- 
tient coughs mostly in the evening after lying down. Stannum 
sputum usually has a sweetish taste; sometimes it has a saltish 
taste. The cough is worse from lying on the right side (reverse 
of Phos. and Lycop.) ; profuse sweats attend our graver cases, 
the sweat smelling mouldy or musty, and appearing on the 
neck more than elsewhere ; fever apt to appear in the after- 
noon from 4 to 5 p.m. (Lycop.) ; chill at 10 a.m. (Natr. mur.) ; 
9 



122 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

hands burn when fever is on. Many of the symptoms gradu- 
ally increase and decrease. We give a few typical cases, some 
of which it is more than probable had tubercular complica- 
tions but the physical diagnostic symptoms are not given. 

" M., set. 36, has suffered since spring from catarrh and lung 
trouble. On August 4th, I found the following symptoms, 
which had existed for a month: his teeth seem loose and too 
long; much phlegm in the throat; morning and night a 
scratching sensation in the throat ; roughness in the throat ; 
cough provoked by tickling; cough with greenish expectora- 
tion of disagreeable sweetish taste; worse in the evening; 
hoarseness; in the evening oppression in the chest, with anx- 
ious apprehension ; asthma ; cannot get breath when making 
a slight motion, and he is often obliged to unbutton and open 
his vest to get a chance to breathe; stool greenish and scanty; 
great burning of hands and feet; lassitude of the entire body; 
very weary and sleepy ; profuse sweat every morning after 4 
o'clock; emaciation; the patient is indisposed to talk; takes 
no comfort in anything and is discouraged. Cured perma- 
nently in three weeks by Stannum 3 ." — Schreter, in Ann. I, 
150. 

" M., set. 37, has been sick for two years; hereditary consump- 
tive habit; unsuccessful allopathic treatment. Symptoms: 
patient very pale and emaciated; breathed short and quick; 
coughed often; dry, or followed by copious greenish-yellow, sweet 
expectoration, especially morning and night; stitching headache, 
especially in the forehead; worst after coughing; appetite increased, 
with subsequent pressure in the stomach and scanty stools; 
heaviness and coldness of hands and feet, with slight oedema; 
in the evening flushes of heat and thirst. Cured by Stan- 
num 18 in repeated doses." — Schubert, in Prakt. Beitr., I, 119. 

"H., tall, thin, of consumptive habit; set. 50. Ten years ago 
had endocarditis and pleuritis. Was taken sick again a few 
weeks ago. Symptoms: lassitude; pain in every limb; con- 
stant irritation to cough; repeated shivering during the day, 
and profuse perspiration early in the morning in bed,; is now 
confined to his bed; cough uninterrupted ; constant; expecto- 
ration of astonishing quantities of tasteless, white mucus; un- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 123 

quenchable thirst; great desire for sour milk; allopathic treat- 
ment unsuccessful. Stannum 6 , followed by aggravation then 
cure."— Gross, in Arch. XVIII, 2, 61. 

"A stout, thickset man, set. 54, was taken with prurigo, and 
in consequence of the continued scratching had eventually an 
ulcer on the leg, probably result of heroic treatment. Includ- 
ing of course the due amount of anointing him with salves, 
his condition became thoroughly broken down, and he suffered 
from digestive troubles, jaundice, asthma, etc. At last cough 
set in, with tickling in the throat; loss of appetite; fever; 
drenching night sweats. Deglutition of fluids became more 
and more difficult, causing suffocative paroxysms with violent 
coughing; expectoration increased in quantity; at first slimy, 
then pus-like, averaging daily more than a pound; hoarseness; 
emaciation; the epiglottis covered with pus; margins ulcer- 
ated; death was expected hourly. Stannum 6 , one dose, was 
followed by a night's good sleep, the first in two years. Visi- 
ble improvement during the next few days, and complete cure 
in a few weeks." — Clotar Mueller, in Pr. 31. 8., VII, 2. 

For a more exhaustive discussion of the treatment of catarrh, 
the reader is referred to our work upon " Catarrh of the Nasal 
and Respiratory Organs." 



CHAPTER XIV. 
PNEUMONIA. 



We think a careful distinction should be kept between pul- 
monary phthisis and pneumonia proper. But it is equally 
important that we recognize the fact that the deposits of pneu- 
monia may become transformed into cheesy products which 
are likely to break down the lungs and open up cavities ; that 
the presence of undissolved and unabsorbed products so de- 
posited are a source of irritation keeping up a sort of chronic 
inflammation which favors the tubercular deposit or cheesy 
exudation. This continued pneumonitis is a menace, espe- 
cially to all persons with any predisposition to phthisis or even 



124 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

persons of a low vitality, if not of itself a cause sufficient in all 
particulars to bring about tubercular deposit and the fatal 
consequences following. Perhaps this is more fully manifested 
in interstitial pneumonia or where chronic inflammations 
follow infarctions and blood extravasations. The clinical re- 
cord given in this chapter presents cases for the most part 
coming from croupous and lobular pneumonia of rather recent 
origin. 

Pneumonia is treated of under the terms catarrhal pneumo- 
nia, croupous pneumonia and interstitial pneumonia. In ca- 
tarrhal pneumonia we have a bronchitis extending to the 
alveoli and from there to the parenchyma ; it is what has often 
been termed lobular pneumonia, because it affects the lung in 
a more limited way than fibrous or croupous pneumonia. It 
may diffuse itself all over the lungs in the form of isolated in- 
filtrations ; it is a disease especially of young children and of 
old age ; yet it occurs at other periods of life. The physical 
diagnosis is not easily made out from the fact that there are 
apt to be pervious alveoli so near the occluded cells that we get 
resonance too well marked to be able to decide on condensa- 
tion. We judge more from the sounds indicating a capillary 
bronchitis, from the retraction of the lower ribs during inspi- 
ration and from the absence also of critical periods and fluc- 
tuations which usually attend other varieties of inflammation 
of the lungs. The condensation proceeds slowly and from 
below upward usually. It is important that the alveoli be 
cleared and all condensation be removed before discharging 
such patients or we may have as the sequel, pulmonary 
phthisis. 

Croupal Pneumonia or Fibrous Pneumonia. — This disease is 
what most authors usually mean in speaking of pneumonia. 
It more often attacks the right side and begins in the lower 
lobe ; the inflammation probably begins in the minute bron- 
chioles and the alveoli at the same time, throwing out . a fibri- 
nous exudation upon the mucous surfaces. By this means 
we get the vesicular murmur so characteristic of the disease. 
As the inflammation extends, the alveoli become blocked and 
the parenchymatous tissue is attacked, occasioning the conden- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 125 

sation known as hepatization. We have resolution by absorp- 
tion of the adventitious products, or there remains a perma- 
nent condensation which later may take on tubercular com- 
plications. The case also ends more rarely by purulent or 
gangrenous degeneration called the third stage belonging to 
the acute attack. This form of pneumonia usually sets in 
with a severe chill followed by intense fever; the pulse runs 
up to 100 or more, the temperature to 104 or 105 in the even- 
ing, dropping from one to two degrees in the morning. Res- 
pirations increase from twenty to forty or more per minute ; 
this would indicate an active pneumonia. The dangers arising 
from this form of pneumonia cannot better be stated than by 
inserting what Rokitanski has written. In speaking upon tu- 
bercle as it affects the lungs he makes two classes of cases ; 
one class derived from " interstitial tubercular granulations" 
which is the millet-seed variety, and deposited, as he says, in 
the interstitial cellular tissue between the smaller lobules and 
the air-cells ; and the " infiltrated tubercle," which, he says, is a 
deposit made in the air-cells themselves. The infiltrated tu- 
bercular invasion of the lungs he makes to come from croupous 
pneumonia. This is his language: "It (infiltrated tubercle) 
results from a croupous pneumonia of various extent, which 
deposits its products, and these, under the influence of tuber- 
culous dyscrasia, become discolored and changed into yellow 
tubercle, instead of being absorbed or changed into pus. Hence 
tubercular infiltration is a hepatization formed by a tuberculous 
exudation, the pneumonic, originally red and granular struc- 
ture of which gradually becomes paler and grayish-red, with 
a tinge of yellow; it is then dry and fragile, but finally it be- 
comes yellow, moister, of fatty cheesy consistence, and breaks 
down sooner or later into tubercular pus." 

Raue, after speaking of the usual course of pneumonia, says, 
" or the hepatization changes into tubercular infiltration which 
is especially the case when the seat of inflammation is in the 
upper region of the lungs. In such cases the fever does not 
leave altogether, but shows an aggravation every night; cough, 
dyspnoea and dull percussion sound of hepatization continue, 
while auscultation reveals bronchial breathing and bronco- 



126 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

phony." It is not always the case that this fever and cough 
keep up ; patient recovers from all apparent inflammatory ac- 
tion, but there is left a hepatized lung. After a time this hep- 
atized lung breaks down and we have abscesses of the lungs ; 
but before this, more frequently there is associated with hepa- 
tization tubercular exudation provoked by the irritation and 
chronic inflammation which this hepatization causes. More 
often, perhaps, pneumonia has been developed in persons pre- 
viously predisposed to tuberculosis, and it has been a provok- 
ing cause of tubercular exudation and the subsequent breaking 
down of the lungs by abscesses. Pathological anatomy reveals 
not unfrequently traces of pneumonia, and the ravages of 
tubercle in the same lung and set up together. These facts 
urge upon the profession the necessity of thoroughly mastering 
their cases of pneumonia, especially should those with tuber- 
cular tendency be watched. We have observed where persons 
were subjected to repeated attacks of pneumonia that they 
usually died of consumption in the end. It may be a question 
if this inflammatory diathesis is not closely allied to the tuber- 
cular diathesis. Excess of fibrin in the blood is found in each 
class of these cases. Certain it is, that pneumonia only par- 
tially arrested, is the beginning of a retrograde action which 
but too often ends in consumption ; old hepatizations become 
burrowing places for fatal abscesses and gangrenous degreda- 
tions ; constricted capillaries, the seat of imperfect circulation, 
and later, the place of cheesy deposit and tubercle. 

Here will be a class of cases where Lycopodium, Phosphorus, 
Sanguinaria, Silicea, Stannum and Sulphur will find an ap- 
plicability. The means at a homoeopathic physicians hands 
are somewhat illustrated in a few cases we will give, taken 
from our note book and from journals. 

A Miss Green, set. 13, of a nervous sanguine temperament, 
was attacked with pneumonia in the apex of the right lung, 
which became infiltrated through the entire upper lobe. Pa- 
tient had been attended about eight weeks, by two allopathic 
physicians, and case had reached the condition of hopeless- 
ness in their opinion as stated to us by friends. " Galloping 
consumption " was the diagnosis. We found patient troubled 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 127 

with severe dyspnoea; had to have the windows up; could 
only breathe by being elevated to an angle of 45 degrees, 
and had to lie turned upon the right side ; respirations 60 per 
minute and pulse, 160 ; dry, hot skin, and a constantly annoy- 
ing, dry, hacking cough; more severe in the morning and 
evening. Gave patient a dose of Sulphur 20m , Fincke, and put 
her upon Phosphorus 290 . Slight abatement of fever and cough 
in twenty-four hours. Treatment continued with signs of ex- 
pectoration at the end of thirty-six hours. Very free muco- 
purulent expectoration in sixty hours, continuing till apex of 
lung was cleared. Lung in clearing up showed signs by phy- 
sical examination of being badly riddled, but healed kindly 
in two or three months, and patient was fully well in six 
months. The only other remedy given was Pulsatilla, for 
some symptoms connected with puberty. We are very posi- 
tive that in this case there was caseous infiltration. The apex 
of the lung was the principal seat of deposit, and the case at 
the time of our visit was one which very properly should be 
called acute phthisis, though beginning, as we suppose, with 
croupous pneumonia. — G. N. B. 

A Mrs. Seymour was attacked with croupous pneumonia at 
the age of 50. She was of a nervous bilious temperament, 
dark hair and eyes, and quite spare; had been treated a week 
by a homoeopathic physician who had relied on Bryonia and 
Tartar emetic. Found her with a dry, harassing cough, hardly 
expectorating at all, with a sense of tightness across the chest ; 
countenance livid; eyes glassy and dull in appearance; con- 
junctiva yellow, with a marked yellowish tinge all over the 
face; urine brown and somewhat scanty; vital forces nearly 
overwhelmed; patient cachectic and ansemic. Gave Sulphur 200 , 
and put her on Phosphorus. Patient made a good recovery. 
This was an unusually severe case of pneumonia, occurring 
in a weak constitution. A very dangerous case but was 
hardly one of tubercular complication, yet likely to end so un- 
less anticipated by a fatal termination. — G. N. B. 

A gentleman of a sanguine temperament taken with a pneu- 
monia which did not yield kindly to the usual remedies, pre- 
sented on the tenth day the following symptoms : high fever, 



128 PHTHISIS PULMONALIS: TUBEKCULAR PHTHISIS. 

dry cou gh and circumscribed red cheeks, almost livid; mutter- 
ing delirium and dyspnoea; pulse easily compressed. Gave 
Sanguinaria with curative results. Patient was of a phthisi- 
cal family.— G. N. B. 

A young man, set. 20, of a bilious temperament, had an at- 
tack of pneumonitis ending in chronic pneumonia; was 
treated five months, having two homoeopathic physicians from 
whom he took many things. When coming into our hands 
we found dulness in upper right lobe and bronchial murmurs. 
He was harassed with a dry cough, aggi avated by going into the 
open air; inclined to press on the chest when coughing, and to 
bend over; pulse 130; respirations 35 to 45 per minute, with 
night sweats. Our prognosis was unfavorable, but gave him 
a dose of Sulphur 20m , followed with Phosphorus 200 , night and 
morning. Sulphur again in a week and continued Phos- 
phorus. Lungs cleared up rapidly and cough passed away in 
six weeks, leaving patient entirely well and free from all dul- 
ness on percussion. In this case there was infiltrated tubercle 
beyond doubt. — G. N. B. 

E. C, set. 25, of nervous lymphatic temperament, suffering 
from intractable pneumonia, resolution not being accomplished 
at the fourteenth day. At this time the symptoms were: 
sunken eyes; sallow complexion; cough mostly dry and very 
fatiguing, causing pain in the stomach and seeming to start from 
the epigastrium ; much dyspnoea and something of the fan-like 
motion of alae nasi; evening aggravations. Gave Lycopo- 
dium 200 . Patient made subsequent improvement to recovery. 
— G.N. B. 

" A woman, set. 60, had pneumonia (right side) three years 
ago ; later an acute bronchial catarrh aggravated by acute 
gastritis. Symptoms: cough which gives her no rest at night; 
patient is obliged to sit up in bed and cough all night; usually 
dry; often as convulsive and continuous as whooping cough, 
with pains in both hypochondria and right thorax above the 
liver; during the cough stitches, so that the patient is obliged 
to make hard pressure upon the chest with both hands, and 
soreness of the pit of the stomach to touch, with oppression of 
the chest; pressure and fulness in the right side of the chest; 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 129 

after protracted coughing the entire abdomen is sore ; coughs 
day and night; in the morning the patient raises thick, heavy, 
purulent matter; she is exhausted, emaciated; has no' appe- 
tite whatever; the cough is increased by talking and cold air; 
no fever. Gave Phosphorus 30 . Four doses completely re- 
moved the symptoms. Later, if she coughed at all, there was 
an entire absence of purulent matter or blood." — Knorre, 
Allg. Horn. Zeitg., XIX, 288. 

Dr. Lorbacher reports a case of interest, where there was a 
complication of cheesy pneumonia and infiltrated tubercle. 

"American, set. 19, of tall stature, with decided predisposi- 
tion to phthisis. Patient took cold in January and came to 
us in April. Physical examination showed the upper right 
lobe obstructed over a large space; there was marked dyspnoea 
on walking, and especially from ascending stairs, accompanied 
with lancinating pains ; recently an evening fever had set in, 
followed by profuse night sweats; bowels were loose; appetite 
poor, with steady loss of flesh; cough chiefly of a dry charac- 
ter, excepting in the morning, when there was a copious ex- 
pectoration of a greenish-yellow matter; chest symptoms ag- 
gravated in open air, and sputa frequently had a tinge of blood. 
Phosphorus 30 , dose every other evening for two months effected 
a cure." 

Another typical case from our own note-book is that of 
Charlie Bojmton, set. 4; light complexion; soft fibre; blue 
eyes and of scrofulous predisposition; was attacked with in- 
flammation of the lungs, in February, 1868. Family physician 
called and managed the case till he was baffled, and told friends 
there was no hope, as the boy was dying of quick consump- 
tion. Found patient terribly emaciated, with a high fever, 
small, quick pulse, and constantly harassed with a dry cough 
exceedingly bad to bear; chest, upon the right of the median 
line badly flattened and contracted, so as to give a concave ap- 
pearance, the centre of depression being at the middle of the 
sixth rib ; patient was w 7 eak and irritable, crying out and com- 
plaining at almost every attempt at coughing; considerable 
space over right lung was dull on percussion; patient had to 
lie bent upon the right side; cough harasses him all day, 



130 phthisis pulmonalis: tubercular phthisis. 

rather worse early in the morning. The pneumonitis was in 
lower lobe in this case, but probably we had infiltrated tuber- 
cle. A few doses of Bryonia, followed with Phosphorus 30 and 
continued three weeks at diminishing intervals, brought about 
decided improvement; and Phosphorus 200 continued, a dose 
once in two days for three months, brought the child com- 
pletely out of all this trouble; flattening and curving of the 
chest, all dulness and the cough entirely disappearing, while 
flesh and advance in growth took the place of extreme ema- 
ciation. There was never any great amount of sputum ex- 
pectorated; everything obstructing the free action of the lung 
being carried away by absorption. — G. N. B. 

"A furniture maker, set. 35, of well-defined tuberculous dia- 
thesis has had yearly attacks of pneumonia under the care of 
a " regular " physician. From the last attack he did not rally. 
Symptoms: the throat was raw, hoarse and dry; the chest felt 
to him as if filled with pus ; the cough was very exhausting, 
causing him to tremble all over; the violent stitching pain in 
the chest had left him, but there was much general irritation 
throughout the chest; the yellow, pus-like expectoration tasted 
salty and was most copious in the morning and evening; the 
eyes were unsteady and he could hardly speak a word without 
being interrupted by short, harrassing hacking; constant chil- 
liness, especially toward evening, interrupted by flashes of 
heat; at times he complained of tearing and stitching pain all 
through the chest; again the pain seemed beating, or the whole 
chest seemed raw and greatly oppressed ; he had night sweats 
and tumbled all night on his couch of shavings. After having 
been treated by the "regular" attendant he received Phos- 
phorus 30 ; on the third day he was more comfortable ; on the 
fourth he had some sleep ; after a week the hoarseness and 
nightly fever disappeared ; his voice became stronger and he 
improved gradually and sufficiently to again perform his ac- 
customed labor." — Hernpel and Arndt's Materia Medica, from 
Bethon in Annal. d. Horn. Klinik., 1, 340. 

Frank Nixon, set. 22, tall, pale, of lymphatic temperament, 
prominent shoulders and flattened chest; family scrofulous 
and had a brother die with pulmonary phthisis a year ago. 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 131 

Had an attack of croupous pneumonia in May ; attack was 
upon the left lung, involving both the apex and middle lobe. 

Case was treated by the dominant school till abandoned as 
hopeless. At our first visit we found patient lying upon the 
back, with sunken eyes, and looking dark about the lids ; eyes 
lustreless, pulse 140, respiration 35 per minute; perspiration 
was standing on face and the whole body was drenched ; per- 
spired upon the slightest exercise; the feet were swollen, no 
appetite and little thirst. Accompanying these symptoms, a 
violent, racking cough, worse at night, and worse from lying 
upon either side; expectoration of large quantities of glairy 
mucus intermingled with a reddish-yellow, or brownish-col- 
ored sputa of putrid odor. Gave Mercurius 200 . Next day per- 
spiration less and cough is less exhausting; continued Mer- 
curius ; third day, drenching perspiration nearly gone ; urine 
heavily loaded with brick-dust deposit. Gave Lycopodium 200 , 
and kept patient upon it until his recovery was completed, 
supported occasionally with a dose of Cinchona 30 . The reason 
for giving the Cinchona being debility from the long drains 
occasioned by excessive sweating and copious expectoration. 
Patient discharged in eight weeks free from any indications of 
condensation in the lung tissue, and had gained his usual 
weight of 180 pounds. His mother at this date is suffering 
from an ovarian tumor upon the right side, and we have just 
cured a younger sister of amenorrhcea from anaemia. — G. N. B. 

The cases given in the clinical report show what can be 
done with croupous pneumonia when attacking scrofulous and 
phthisical constitutions when remedies are well chosen. There 
can be no doubt but that tubercular infiltration was fairly set 
up in a portion of these cases, and they are all of a sufficiently 
grave character to be worthy of study. For the usual treat- 
ment of this disease, in its more acute stage, the reader is re- 
ferred to accredited text-books upon pneumonia. 

Interstitial Pneumonia. — Rokitanski in speaking of this 
disease remarks that as a rule it is not correctly described in 
works upon pathological anatomy, as it is usually regarded as 
a chronic form of croupous pneumonia, whereas the true seat 
of the inflammation is the interstitial cellular tissue. Possibly 



132 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

the walls of the air-cells may become affected by the extension 
of the inflammation so as to involve them, when we would 
have a complication of the croupal form added to the intersti- 
tial pneumonia. 

Interstitial pneumonia is always chronic in its character, or 
almost always at least ; it commences as an inflammation in 
the cellular element, situated in the interstices between the 
lobules and the smaller groups of the air-cells, and the inflam- 
mation throws out an albuminous product which becomes or- 
ganized and coalesces with the interstitial cellular tissue, so as 
to form a dense cellulo-fibrous substance which obliterates the 
air-cells by compression. This is so analagous to the process 
of tubercularization, as described by Bennett, that one can 
well conceive that the ground, by such an inflammation, is 
prepared for the sowing of tubercle. Its most common seat is 
the apices of the lungs, as is the case with caseous exudation. 
The above quoted authority regards that it more commonly 
arises out of the reactive inflammation which sets in around 
apoplectic effusions into the lungs, lacerations of the lungs, 
and pulmonic abscesses ; and to this he adds tuberculous cavi- 
ties and gangrenous destruction. Interstitial pneumonia then 
prepares the way for tubercular occupation of the lungs, and 
also favors the extension of tubercular infiltration when once 
set up at any point in the lungs. The importance of recog- 
nizing this fact is very material, though often difficult. It 
will be conceded that we have most ample means at our hands 
for controlling pneumonic inflammations. If our cases of 
hemoptysis have been well managed, we shall avoid many 
cases of interstitial pneumonia, and to the treatment of hemop- 
tysis we have devoted an entire chapter. But having a case 
of interstitial pneumonia to deal with, we shall be obliged to 
study for indications with great care as in the treatment of 
other difficult diseases. Bryonia, Iodine, Iodide of mercury, 
Lycopodium, Mercurius corrosivus, Myrtus communis, Phos- 
phorus and Sulphur we mention as the more probable remedies 
where the homoeopathic correspondence will be found. These 
can be studied in detail, as well as the special chest symptoms, 
in Hering's Condensed Materia Medica, Rane's Pathology and 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 133 

Therapeutical Hints, and for the most part in subsequent chap- 
ters of this work. 



CHAPTER XV. 
COMPLICATIONS IN PHTHISIS. 

Pharyngeal Complications. — In granular pharyngitis we 
have the caseous deposit, not very dissimilar from the caseous 
deposit in phthisis ; also the calcareous deposit the same as is 
found in the tuberculated lung. Drs. Sappey and Robin re- 
port the histological changes to be thus : " The tubules of the 
follicles were found considerably enlarged, both as regards the 
diameter of their cavity and the thickness of their walls. In 
the follicles which were most hypertrophied and indurated, 
small calcareous concretions were discovered, composed prin- 
cipally of the carbonate of lime; in some of the glands these 
w T ere numerous and packed together so closely as to present 
when detached, a crystalline appearance, owing to their sur- 
faces having been moulded into polyhedral faceted figures. 
The diseased glands appeared to be less vascular than in the 
healthy pharynx; the cheesy secretion appeared to consist of 
the debris of epithelial cells, of molecules and oil globules." 
The similarity to the histology of tubercle in the lung is suffi- 
ciently noticeable. 

Dr. Green thinks phthisis may take its origin in granular 
pharyngitis, while Dr. McKenzie thinks not, but gives the re- 
sults of observations made by Frankel in a case of actual 
phthisis with tubercular ulcers in the lateral walls of the 
pharynx, on the roof of the mouth, extending to the nasal por- 
tion of the posterior wall of the pharynx, and on to the velum 
palati; but these are said to cease abruptly at the opening of 
the oesophagus. It is said the base of the ulcers were found to 
be occupied by a thick infiltration of what appeared to be round 
cells, extending deeply into the sub-mucous tissue, often even 
as far as muscular tissue. The round cells also infiltrated the 
connective tissue of the glands but did not invade the special 



134 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

gland cells, which usually appeared to be in a state of fatty 
degeneration. He further says, they have a tendency to be- 
come cheesy. Both lungs exhibited cheesy broncho-pneumo- 
nia and gray nodules. A cavity was also found in the left 
lung. Tubercles were found in the pleura, liver and spleen, 
and tuberculous ulcers in the intestines. We do not attempt 
to settle the difference in opinion between these two gentlemen. 
Dr. McKenzie adds, "Tuberculosis of the pharynx appears to 
have been generally confounded with syphilis, and to this fact 
the comparatively scanty amount of clinical observations is 
probably due." " The lenticular ulcers of pharyngeal phthisis, 
with the development of gray nodules in their neighborhood," 
he makes very characteristic of tubercle. 

Tubercular Affections of the Larynx. — The cause of tu- 
bercular deposit in the larynx is not as yet fully settled by 
the medical profession ; some insisting that it is the poison of 
the sputum coming from tuberculated lungs (auto-infectious), 
while others think it to be in the main the same cause which 
occasions tubercle of the lungs. Heinze has given us an ex- 
haustive monograph which leaves little more to be said upon 
questions of etiology and pathology. From the fact that tu- 
bercle is occasionally found in the lungs, if found in the larynx, 
and with indications of being an older deposit in the lungs, 
the inference is that it spreads to the larynx as the disease 
progresses in the lungs, and as the development of the ca- 
chexia goes on. It is a fact that the lungs will usually be 
found infiltrated if we have tubercle of the larynx. McKenzie 
makes the broad statement that " In the case of adults, at least, 
tubercle is rarely, if ever, found in any organ or tissue of the 
body, unless it has been previously deposited in the lungs." 
Men are more often affected than women, and the vigorous 
period of man's life, from twenty to forty, is the time at which 
the disease is most common. This may suggest the influence 
of catarrhal attacks in multiplying these cases. It may also 
suggest questions pertaining to the virile powers of man. 

Louis, who maintained that the pulmonary sputa was the 
chief cause of tubercle in the larynx, was compelled to admit 
that the ulceration bore no relation to the irritative quality of 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 135 

the expectorated matter. The fact also that the ulcers are 
scattered about in the laryngeal mucous membrane goes to 
disprove the theory that the sputum is the sole cause of the 
ulcers. It is pretty safe to say that anything which tends 
to produce weakness or chronic inflammatory action in the 
larynx, tends to bring on a condition favorable for a tubercu- 
lar attack, if the scrofulous cachexia exists. 

Many persons date a laryngeal phthisis to a severe attack 
of catarrh; others to overwork of the vocal organs. Heinze 
thinks tubercular infiltration of the larynx occurs in about 
one-half the cases of phthisis pulmonalis. The parts affected 
are the ary-epiglottic folds, the epiglottis, the ventricular bands 
and the vocal cords; the first two being more often affected it 
is thought, and more extensively thickened by the deposit. 
Chronic oedema almost always attends the tubercular deposit. 
Thickening always attends, and ulceration on the cadaver has 
been found in about one-fifth of the cases examined. The 
epithelium does not seem to be much affected till ulceration 
takes place. " The deposit," says McKenzie, " consists of tuber- 
cles which are made up of more or less circumscribed collec- 
tions of cells of various shapes and sizes, having a somewhat 
concentric arrangement upon a scaffold of lymphoid reticulum. 
The tubercles, some very small and some as large as a millet- 
seed, have frequently in their centre a giant cell, around which 
are lymphoid cells, and some few larger cells with nuclei of 
high refractory power. The tubercular deposit is found both 
in the mucosa and the sub-mucosa, but always above the layer 
containing the mucous glands." 

This goes to prove that miliary tubercle is usually associated 
with caseous degeneration of the lungs. Ulceration is the 
common sequel of tubercular deposit in the mucous membrane 
of the larynx, provided the patient lives long enough. Some- 
times the tubercular deposit begins in the glands, the round 
cells deposited in the interstices between the acini gradually 
crowding upon the membrana propria and leading to the de- 
struction of acinous structure, so that a capsule which ordi- 
narily would contain thirty acini, perhaps is found to hold no 
more than half a dozen. At last the capsule is destroyed and 



136 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

there only remain isolated portions of degenerate gland struc- 
ture. The ducts have a greater power of resistance and may 
be found intact. The blood-vessels, including the capillaries, 
have the same power of resistance. This is the ordinary course 
of the ulcer. 

Tubercle is very seldom detected in the muscular structure, 
but Heinze found among his many autopsies two cases where 
they were present, and Frankel found fatty degeneration of 
the contractile tissue and corpuscles in muscular structure. 
To sum up: the semi-solid pyriform swellings of the ary- 
epiglottic folds are the most characteristic lesion to be found, 
and may be regarded as almost conclusive if found. Yet there 
may be tubercle and not so well-defined a thickening exist. If 
doubt is felt, an auscultation of the thoracic walls may settle 
the point, for if tubercle be found in the lungs, the probabili- 
ties of tubercle in the larynx would be very great. If auscul- 
tation gives negative results, the sputa should be examined to 
see if any elastic lung tissue is expectorated. 

The diseases with which it may possibly be confounded are 
chronic oedema, chronic laryngitis and syphilis of the larynx. 

If chronic laryngitis, the swelling is usually less than if tu- 
bercle be present, but there is more hyperemia; in oedema 
the transparency is more apparent from the excess of fluids; 
yet in the later stages this is of less importance as a differentiat- 
ing symptom, for the reason that oedema often exists there as 
the result of tubercle. In syphilis there is less regularity of 
the hypertrophied tissue, and the ulcers are larger in size and 
more solitary. They commonly surround a red, inflamed ring 
— more often two are upon one side. In phthisis, the ulcers 
are small, numerous, scattered, and a pale ground-work is 
seen where they are sown. The hyperplasia is more uniform, 
is smooth and even. If syphilis assails the epiglottis, for in- 
stance, the free edge and upper surface is usually the place at- 
tacked, while tubercle is more frequently found on the under 
surface. 

Ulceration of the arytenoid cartilages from syphilis is very 
rare, while from tubercle it is most frequent. Both diseases 
may attack the vocal cords, but syphilis usually attacks but 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 137 

one cord, while phthisis will be likely to attack both. Again 
the extent of tissue broken down is likely to be much more 
from a syphilitic ulcer than from an ulceration following a tu- 
bercular deposit. 

If phthisis and syphilis be conjoined, of course obscurity 
and doubt must increase. 

The known effects of Bromine, Causticum, Iodine, Kali 
bichromicum, Kali hydrojodicum, Lachesis, Mercury and Nit- 
ric acid, suggest them as remedies to be consulted in this com- 
plication, either as adjunctive to some constitutional remedy, 
or as likely to be the agent meeting the entire similimum. 

That tubercular affections of the throat have often been 
overlooked upon the presumption that syphilis was present, is 
more than probable. 

That we have syphilis complicating many cases of pulmo- 
nary and laryngeal phthisis, admits of no doubt. To analyze 
and so separate these factors so as to give proper value to each 
dyscrasia is exceedingly important. It is now well known 
that we have syphilis pulmonalis as well as laryngeal syphilis. 

The work of disintegration in syphilis in both places goes 
on more slowly and with less acute constitutional symptoms. 
The febrile excitement and the rapidity of tubercular degener- 
ation as compared with the progress of syphilization ' is im- 
portant in diagnosticating our cases; and our treatment will 
be modified as we decide upon the presence of the one or the 
other or both dyscrasias. 

Intestinal Complications. — We have tubercles sown in the 
mucous membranes of both the large and small intestines, 
more particularly about the ileum. The glands here often 
become so studded with tubercular deposit that the membrane 
becomes a thickened mass, greatly narrowing the caliber of 
the tubes. Sometimes the inflammation will, by its action upon 
the muscular and serous structures, produce such contraction 
as to almost amount to a stenosis. More frequently the tuber- 
cles are found to attack the aggregated glands than otherwise ; 
but you may see here and there a solitary yellow tumor not 
larger than a hemp-seed projecting from the mucous surface, 
not involving to any great extent the bowels, but yet showing 
jo 



138 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

that this is proper soil for the lodgment of such seed. As 
ulceration goes on, you will see a ragged border around the 
ulcerating centres, where glands are being broken down. 
Louis found tubercle in the intestines in a larger part of the 
fatal cases inspected, dying from pulmonary phthisis. It is 
usually regarded that tubercle in the intestines is secondary 
to its deposit in the lungs. I am not sure but there may be 
exceptions. The diarrhoea attending ulceration of the intesti- 
nal tract in these cases greatly tends to exhaust our patients. 
Tubercle in the intestines must also greatly impair the nutri- 
tive functions. We know of no better remedies in these cases 
than Calcarea carbonica, Calcarea phosphorica, Silicea and Sul- 
phur, though the characteristic indications must be followed. 
We have seen really very wonderful effects from Calcarea 
carbonica, and make a clinical point for its use. What the 
nosode Tuberculinum may be able to do, we are not able to 
say; but it is well to remember that we have a similar prepa- 
ration of the carbonate and phosphate of lime. The stomach 
also is apt to become enlarged and thinned out in its walls in 
the progress of a phthisis. I do not know as this indicates 
anything more than a wasting of tissue as occurs through the 
general system, and weakness of the muscular structure. But 
the fatty degeneration of the liver found so often must have a 
significance. Some regard the fatty degeneration almost pecu- 
liar to this disease. The gland enlarges and becomes full of 
adipose matter ; the whole gland loses its natural color and 
becomes pale and soft in consistence. This indicates a change 
in transformations, or arrest of fatty matter in course of desti- 
nation for fulfilling some important function in the animal 
economy. I suggest whether these may not be the cases where 
Phosphorus is found to act so favorably. 

The generally accepted theory that the bile and pancreatic 
fluid are the chief solvents of amylaceous matters, may lead 
most to think that partial arrest of the functions of the liver 
and pancreas growing out of a general debility following the 
progress of a phthisis, is sufficient to explain this fatty degen- 
eration. But we have debility in ansemia, in continued fevers, 
and in many other diseases without this fatty degeneration. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 139 

I think we will have to look further for the cause of this 
complication. 

Whether this presents an abortive attempt of nature to set 
up a curative process we do not pretend to say. 

The need of fat to make blood-corpuscles has led most phy- 
sicians to giving oils and amylaceous food to consumptive pa- 
tients. 



CHAPTER XVI. 
REGIMEN, CLIMATE AND SURGICAL DRAINAGE. 

Before entering upon the analysis of remedies found in the 
Materia Medica there are some therapeutical adjuncts to which 
it may be profitable to give attention ; among these are cloth- 
ing, food, climate and surgical drainage. 

We have laid great stress upon thorough removal of extra- 
neous matters from the system, such as the carbon and nitro- 
gen products, and indeed, every other component of the excreta. 
We have spoken of the importance of filling the lungs at the 
time of inspiration if we would avoid mechanical blocking up 
of the air-cells, and obstructions in unused portions of the 
lungs, and have said that the oxygen received is indispensable 
to the work of transformation perpetually going on in the 
system. 

It is not saying too much when we affirm that a compressed 
lung is a perpetual menace upon life. 

How many dress so as to give absolute freedom to the lungs, 
especially of the fair sex? Pressure could hardly be applied 
to better advantage than by forcing up from below after the 
manner of the corset. There is not space enough left in the 
thoracic cavities to expand the whole of the lungs; the pres- 
sure will be most effective at the apices, and it is just here 
where we most frequently find tubercle. Not only should 
pressure be taken off, but the muscles which lift the thoracic 
walls should be educated and developed, so that by their con- 
tractile energy the walls will be kept off from the lungs them- 



140 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

selves. All curvatures of the spine, all contractions of the 
chest should be promptly attended to, as having a tendency to 
impair the respiratory function by compression. Systematic 
and trained muscular movements, also systematic thorough 
inflation of the lungs cannot be too strongly urged upon 
those having any tubercular tendencies, always to be used ac- 
cording to the power of endurance. Then surgical appliances, 
such as the plaster of Paris splint, or felt jacket may be 
necessary adjuncts if we have curvatures to overcome. Such 
cases will be benefited by constitutional remedies, such as 
Calcarea and Silicea; the diet also should be nutritious and 
easy of digestion. Not only should the clothing about the 
chest and stomach not compress the central vital organs, but 
it should be of good non-conducting material, so as to avoid 
congestions and colds. Besides proper protection to the chest, 
there needs to be great care of the feet; they must not be 
allowed to become damp and cold; silk or woolen hose are the 
best. Frequent bathing in pretty warm water and rubbing 
dry will keep the skin in good condition; and let me empha- 
size this as important both as an eliminating process and for 
purposes of equalizing the circulation and controlling the 
febrile action. Some have advised the use of cold water, 
thinking to prevent cold feet, and also to avoid susceptibility 
of taking cold ; it may be used after the hot bath if only for 
a moment and friction be at once applied to bring about 
thorough reaction. There must be much caution or nervous 
shock and congestions will follow, which will more than coun- 
terbalance the good, but the foot-bath and a free use of the 
bath about all the sweat-glands, such as are located in the ax- 
illa and groin, with towel rubbing, are valuable adjuncts to 
all kinds of treatment. The bath and protection by suitable 
clothing, in no case must be overlooked ; non-conductors, such 
as silks and wools being best next the skin. Application of 
water at the temperature of 50° to the skin, especially about 
the neck and chest, applied with the half- squeezed sponge, and 
only for the moment, followed with free friction we think 
tends to obviate colds. It can so be applied every day if care 
is used. Reaction with a fine glow upon the skin is the test 
of benefit and skill in applying the bath. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 141 

Food. — Milk, sugar, cream, fats of different kinds and malt, 
we have found beneficial in the management of our cases of 
phthisis. The fattening properties of milk and sugar are very 
well known. When we have found the stomach too weak to 
digest milk or cream we have added a little choice brandy to 
whip up its action. 

We have for years been able to heal up a bone ulcer by giv- 
ing the carbonate or phosphate of lime in our dilutions, put- 
ting patients upon a spoonful of brandy added to half a pint 
of milk, three times a day. The red corpuscles rapidly in- 
crease and a cure is almost sure to follow. We have come to 
attribute something of our success to the brandy and milk. If 
chronic ulcers of the bone can be so rapidly repaired in this 
way, why may we not hope to benefit our cases of phthisis in 
a similar way. 

Scrofula is usually behind both of these diseases. 

The more cream the milk has the better, if the digestive 
functions will appropriate it. Cream can often be taken when 
no other kind of fatty foods can be tolerated ; cream and sugar, 
to which may be added a little wine or brandy, or a few. drops 
of muriatic acid, if better relished. Some have advised whey ; 
it is a good carbon hydrate. We have given our patients 
boiled fat pork, appetizing it with a little vinegar or lemon 
juice, when they could take it. We have had patients who 
really craved fat pork and would eat it with avidity. This 
appetite has only shown itself after long fasting and inertia of 
the stomach, and when energetic reaction was setting in. 
Notably was the case of Miss T. of this class (reported under 
Tuberculinum) after taking Tuberculinum. 

We urge upon our patients also, to use malt as freely as the 
stomach will tolerate, taking it with meals or just before. 
Trommer's Extract has been our favorite brand. If patient 
dislikes it, we recommend thinning it with a little beer or pale 
ale, or better still with milk, if milk can be tolerated. 

The fat of corned beef, or fat trimmed from a nice steak can 
be often utilized. We think these fats not inferior to cod- 
liver oil and they are usually more palatable. 

Milk ranks first as a food, so far as our experience goes, in 



142 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

all albuminoid diseases. We use it in albuminuria, finding it 
almost indispensable. Milk and farinaceous foods, like rice, 
oat-meal and the different preparations of wheat, are not as 
likely to cause febrile excitement as meats. The patent-pro- 
cess flour, possessing more of the phosphates and silicates, we 
think the best of our brands of wheat, Graham flour as it 
usually comes from the mills being too coarse. The outside 
of the kernel could more largely be used with great advan- 
tage if we could have it finely ground. 

Sweet apples, strawberries, raspberries, blackberries and 
peaches, may be freely used with farinaceous and fatty foods. 

After all, many will decide to give cod-liver oil. A good 
way to cover the taste is to add a few drops of Sulphuric ether, 
and what is more important, it is thought to excite the action 
of the pancreas upon which the digestion of fats so largely de- 
pends. 

In favor of the oil, statistics show that deaths from consump- 
tion have fallen off some six per cent, since its introduction 
into practice. 

C. B. Williams, of the Consumptive Hospital at Brompton, 
London, in his'Lumleian Lectures observes that, "The expe- 
rience of Louis and Laennec gave an average of two year's life 
in phthisis after it was decidedly developed; but that since 
cod-liver oil was introduced he infers from 7,000 cases, that 
the average duration of life has been four years." Some will 
raise the question if this improvement would not naturally 
follow the dropping of heroic treatment. In other words, if 
the disease, let alone to nature, would not give about the same 
statistics of diminished mortality. 

Whether oil is purely a nutrient or has minute quantities 
of medicinal agents in solution, to add to its value as an arti- 
cle for consumptives, has not been absolutely settled. It is 
pretty certain, however, that it is a nutrient. 

Dr. Williams says : " I have no hesitation in stating my con- 
viction that this agent has done more for the consumptive 
than all other means." Dr. W. has had in his charge many 
thousand cases. 

There is a growing tendency to place fat at the bottom of 
all molecular action in cell-growth. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 143 

Dr. Chambers, speaking of cod-liver oil, remarks, that it is 
"a typical aliment, representing what is the fittest of all 
known substances to supply the deficiency that constitutes the 
disease. Oleaginous substance is what is furnished by nature 
for all primary growth, and nutrition of all the higher tissues 
of all animal bodies; so that in administering it we are wisely 
imitating the wisest teacher of medicine — mother Nature." 

We may properly inquire at this point, what is the signifi- 
cance of fatty degeneration found in connection with tubercu- 
losis of the lungs? 

Is it an imperfect effort of nature to repair herself from the 
conversion of glucose into fat? 

Doubting if we are able to prove exactly what Dr. Chalm- 
bers says, or if we are fully competent from present data to 
answer the questions raised, we may accept as pretty well 
proven, that fat has something of an ameliorating influence 
in a majority of cases of tubercular phthisis. 

If cod-liver oil is used, we should be very careful to select a 
good article; many now use the emulsion. The oil should be 
condemned as unfit for use, if in the least rancid; dark-colored 
oils are almost always impure; pale" or white oils are the only 
ones to be accepted; these should be kept in a cool place, well 
corked, and not exposed to the light; when taken, a few drops 
of Sulphuric ether may be added. The best time to take it is 
about half or three-fourths of an hour after meals; it will then 
pass more quickly from the stomach, as the food will at that 
time be moving downward. For myself I am not convinced 
that cod-liver oil is better than other fats, which are more pal- 
atable. 

Cream has been successfully used in improving the flesh of 
greatly emaciated children when emaciation has been caused 
by defects of nutrition, and also from waste of protracted dis- 
eases, and we have been using it for years with good results 
for our consumptive patients in place of cod-liver oil, support- 
ing it with other fats and malt. In some instances when we 
have had patients suffering from feeble assimilative powers 
and great debility, we have directed that they be well anointed 
with oil twice a day, aiding by absorption through the skin to 



144 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

keep up the motor energy of the system ; and more can be 
done in this way than one thinks. The oil should be well 
rubbed in, aided by heat. 

The value of malt consists in having a large per cent, of 
sugar and dextrine combined with fatty substances, a small 
per cent, of albuminoids and phosphates, making it adapted 
to weak digestion and the conditions of anaemia. 

Much has been said lately about the carbon hydrates in 
the management of consumptive cases, and as supplying both 
motor energy and the constituents of blood globules, we con- 
clude the opinion of the profession fairly sets that way. 

The questions supposed to be settled as to the uses of carbon 
foods and nitrogen foods is likely to undergo a revision. The 
a iceptance of the doctrine of conservation of energy, requires 
also the acceptance of the doctrine that force is transmitted 
from one form into another, and that the forms of force bear 
a fixed and quantitive relation to each other. From the car- 
bons, we assimilate, come the chief manifestations of force in 
muscle, gland, and nerve. 

The functions of muscles, glands and nerves are largely to 
distribute force obtained from these carbons, and in doing this 
such force is often transmuted ; and so long as these carbons 
are supplied but little waste is felt in any of these tissues. 
Hence it is fair to conclude that such carbons are the feeders 
of these tissues, and that starvation will follow if they are 
withheld. It appears also that whatever carbonaceous food is 
not wanted for present use, is stored within the body, and 
chiefly in the form of fat. A trifle of this, it is true, is pro- 
duced from the splitting of albuminous matter, which under- 
goes transformation. Failure of ability to dissolve amylaceous 
foods, and transmute them into fat cells, is one trouble with 
consumptives, making necessary the use of fats in increased 
quantities. Emulsifying these fats, aids in their absorption. 

It is worthy of note that several remedies known to act 
upon the liver and internal glandular system have the symp- 
toms of aversion to sugar or fats. Arsenicum has aversion to 
butter, but desire for milk and lard. Calcarea carb. has aver- 
sion to meat and nausea after milk. Calcarea phos. has colic 



PHTHISIS PULMONALIS: TUBEKCULAR PHTHISIS. 145 

from eating ice-cream. Causticum has aversion to sweet things. 
Ferrum has aversion to meat, which disagrees; after fat food 
bitter eructations. Hepar s. c. has aversion to fat. Lycopo- 
dium, desire for sweets; constant sense of fermentation; con- 
stant sense of satiety. Mercurius, aversion to greasy food ; de- 
sire for sweets, but they disagree. Natrum sulphuricum, fari- 
naceous food causes diarrhoea. Nitric acid has longing for fats, 
but fat food causes nausea and acidity; milk disagrees. Phos- 
phorus, aversion to meat and sweet things; wants ice-cream. 
Pulsatilla, aversion to fat food and to milk. Sanguinaria, sugar 
tastes bitter; sweet things aggravate and cause burning. Sepia, 
diarrhoea after drinking milk; particular aversion to meat. 

Sulphur, aversion to meat, milk disagrees; desire for sweet 
things; a good remedy when sugar disagrees. Thuja, oily or 
greasy substance in stool. Zincum, aversion to sweet things 
and to meat. These are the remedies which have gained the 
foremost place in our clinical reports upon phthisis. The 
symptoms we have given indicate the use of the remedies for 
troubles where fat is not assimilated, and where sugar is not 
readily transmuted into fat. The subject as brought forward 
here is tentative and will bear further study. The function 
of the pancreas being that of emulsifying fats and preparing 
them for assimilation, it would be well to ascertain what reme- 
dies have a special action upon this gland. Recent investiga- 
tions seem to prove that Sulphuric ether and Sulphur are fore- 
most among these. The function of the liver being largely 
that of converting sugar and starch into fats, it is well to study 
the importance of keeping this organ in a healthy condition. 
I need not mention particularly other organs connected with 
nutrition. 

Climate. — The importance of fresh air, combined with regu- 
lar exercise out of doors, is of great importance in improving 
the circulation and assisting in the elimination of morbid pro- 
ducts. The muscles are strengthened, the heart's action is 
more vigorous, and the nervous system is toned up. 

To facilitate this a choice of climate is of very considerable 
consequence. 

Elevated climatic stations where there will be snow for 



146 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

several months in the year, have the advantage of supplying 
an atmosphere free of dust and also a thinner air. Torpid 
constitutions and those troubled with a slow digestion, are 
often benefited by such an atmosphere; but persons who suffer 
from stimulation, have quick pulse, redness of face and dysp- 
noea, should not go to such a climate; nor should blood-spit- 
ting patients, nor those troubled with laryngeal affections. 
Persons who go to Colorado and other high altitudes, are apt 
to delay their visit too long. They should go in the earliest 
stage of the disease in order to be benefited. A warm, moist 
climate, such as we find in Alabama, Florida, and the small 
islands of the tropics, agrees with a larger number of consump- 
tives, though such a climate is too relaxing for some. If one 
has a bad digestion and is subject to diarrhoeas, he is not likely 
to be benefited. By going inland upon plateaus with higher 
elevation, possibly such may be able to get something of the 
equability of the climate, and escape enteric and stomachic 
troubles also. 

The city of Mobile and its surroundings offers as favorable 
advantages as any we know of in this regard. The atmosphere 
is free from malaria, the soil is sandy, and at no great distance 
away are to be found elevated plateaus which carry one beyond _ 
the fog and dampness, if this become too depressing. The 
mean temperature is very favorable for avoiding pneumonic 
congestions and inflammations, and such complications are 
usually those the patient and physician most fear. Only twice 
in the years between 1869 and 1880 did the thermometer regis- 
ter on any day in the months of December, January and Feb- 
ruary as low as 20°, and that only in the night. The extremes 
were from 80° to 20°. In the majority of the years the mer- 
cury only ran down to 28°. March and April are always 
pleasant months in this vicinity., This enables the patient to 
spend much of his time in the open air. 

Six miles from the city there is elevated ground, pure water, 
beautiful scenery with balmy breezes blowing from the gulf, 
all favorable to the repair of diseased lungs. If the air is ever 
too damp here, the cars will carry one in two hours to the pine 
hills, wholly beyond any depressing influence of this kind. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 147 

Such being the topography of the country, one may spend 
most of his time in the city, sure of a safe retreat near at 
hand, if at any time he has need. 

As a rule we ought never to send our patients away from 
home when the febrile symptoms are active and all indications 
show the disease making steady progress. Patients are often 
sent away who should be in bed half of the time, receiving 
treatment to allay actively progressing movements of the dis- 
ease, and when better, may be sent away if thought best ; but 
sending people away from home to die, is not complimentary 
to the physician, while to the patient it is a cruelty. 

The remarkable cures reported from persons camping out in 
the Adirondack region within the past two years, only proves 
the importance of securing good air, and exercising in it. A 
better elimination of effete products is thereby obtained, and 
consequently a better digestion. This can be secured in almost 
any dry northern woodland with variegated scenery, by se- 
lecting a sheltering crag. 

Camping out in the Alabama woods would be less rigorous 
in winter, and prove to a majority, we think, a better success. 
Acclimation, however, is a great point, and hardening where it 
can be accomplished is a part of the cure. TJie air, the air 
should be the first part of the prescription to every consump- 
tive patient; and to secure its entrance into all the air-cells, 
we should order the use of the respirator or other pneumatic 
apparatus in a systematic manner. 

In all tables of statistics yet published where the mortality 
of phthisis has been the subject, there has been an invariable 
increase of fatality, and numbers where the habits have been 
sedentary and of in-door life. No matter what the climate, 
out-of-door life is beyond dispute beneficial to persons with 
pulmonary tendencies. Agricultural pursuits are much to be 
preferred to work behind the counter or in a dusty shop. A 
quiet, easy life, as the country gentleman might follow, would, 
to our mind, be representative in character. Riding, hunting 
and fishing, and other sports followed out-of-doors, give the 
proper stimulus to the muscles, quicken the digestion, and 
help to thorough breathing. If the lungs are broken down, 



148 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

then exercise will have to be passive, such as one gets from 
riding in an open carriage, being rowed in a boat, or from 
swinging in a hammock. 

One may lie for hours basking in the sun and fanned by the 
cool air, to advantage. Sun-baths and air are not only enjoy- 
able, but indispensable. We must remember the skin has a 
wonderful eliminating power. "The poison of a rabid dog, 
a snake bite, and other infectious poisons," says an eastern 
physician, "may be wholly eliminated from the system by 
baths at 130° to 150° Fahrenheit; and vaccine matter does not 
take if excessive perspiration follow soon after the inoculation." 
The value of thorough breathing and exhalation from the 
skin cannot be overestimated. 

Summing up what may be said of climate: a sunny, dry, 
cool and stimulating climate is undoubtedly the best, not too 
cold nor too hot, nor is a high altitude to be chosen except for 
sluggish natures needing a constant stimulus. Northern New 
York, the shores of Lake Michigan or Colorado in summer, 
Santa Barbara, Alabama or Florida in winter, for such as are 
able to bear the expenses of a migratory life, would seem to 
meet the climatic requirements, as well as may be done in the 
Western continent. I have been persuaded that the equability 
of temperature along the eastern shores of Lake Michigan 
offers some advantages to the consumptive invalid, but the 
locality has the objection of being malarious till you reach the 
upper portions of the lower peninsula. 

The western shore from Chicago to Milwaukee has a dryer 
atmosphere, a sandy soil free from malaria, and statistical 
health tables place the locality in the front rank for sanitary 
resort. A sanitarium for consumptives at Waukegan on the 
west side, and at Petosky on the east side of Lake Michigan 
would be well located. Minnesota and northern Wisconsin 
are favorable localities. 

Hot Baths. — There is no doubt that free exhalation carries 
from the system large quantities of poisonous and effete matter. 
Under the action of a bath at 90° to 100° Fahrenheit, the 
rheumatic morbific agent is expelled. Some have gone so far 
as to report the elimination of the virus of rabid animals by a 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 149 

bath of 135° to 145° after spasms had actually set in. We 
know that nature sets up the sweating process to remove dead 
matter from the body. What is the significance of the drench- 
ing sweat of the consumptive? I do not suppose that we are 
to drift tubercle from its lodgment in the lungs by baths at 
any temperature, but when nature declares her efforts at elim- 
ination by the sweating process, it is well to inquire if we may 
not act upon the hint. Sun-baths are found to be good and to 
protract life, but I do not know that water-baths of a high 
temperature have as yet been tried. It is our opinion that 
they can be made adjuncts to well chosen medication. Drain- 
age of effete and tuberculous matter, either by an opening 
through the walls, or the emunctories will tend to obviate the 
very general evil of auto-infection. 

Surgical Drainage.-The subject of making openings through 
the thoracic walls, has been recently discussed on both sides 
the Atlantic, and tried in a few cases. Professor Mosler, of 
Griefswald, read a paper before the Society of Naturalists and 
Physicians, assembled at Wiesbaden on September 23d, 1873, 
in which he presented the plan of opening into pulmonary 
cavities and inserting drainage tubes. This plan also inclu- 
ded appropriate topical treatment by access to the walls of the 
cavity through the opening. 

Professor William Pepper, of Philadelphia, was engaged upon 
investigations of a similar character about the same time. 

In the Philadelphia Medical Times for March 14th, 1874, 
Prof. Pepper published a paper " On the Local Treatment of 
Pulmonary Cavities by Injections through the Chest Wall." 
The American Journal of the Medical Sciences for October, 1881, 
has a paper upon " Opening and Drainage of Cavities in the 
Lungs," from Drs. Fenger and Hollister, of Chicago, suggestive 
in its character. 

That abscesses may exist in the lungs and recovery take 
place has been conclusively proved. That cavities may be 
safely opened into is well agreed upon. If they arise from tu- 
bercular deposit it is not agreed whether anything can be 
gained by drainage through the external walls. Our own ex- 
perience only extends to opening into a cavity of a scrofulous 



150 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

nature when there was a slight prominence between the ribs. 
It was in the case of a young man whose mother died of phthi- 
sis. The cavity partook of the nature of an abscess, and puru- 
lent matter was expectorated freely, while from the opening 
large quantities of purulent matter continued to flow for sev- 
eral weeks. The case was saved no doubt because of the su- 
perficial character of the abscess. 

A good recovery followed, but the chest walls were some- 
what contracted. Echinococcus cysts of the lungs are success- 
fully treated by drainage through the walls, as well as empy- 
ema. But it has generally been thought that the lung must 
be so extensively involved in the tuberculous degradation be- 
fore pus cavities form, and the vital powers so far prostrated 
that the operation is not warranted save in very exceptional 
cases, when the lesion is superficially situated, with adhesions 
of the pleura to the chest walls. 

•Deep lesions do not always prevent recovery, unless fatal 
hemorrhage follows. But the more central the wound the 
more doubtful the recovery of any important lesion. It is 
plain the abscess must be clearly located before any attempt 
of this nature can be made ; and if adhesion to the walls exists 
there is much more likelihood of success. 

We are prepared to see sentiment setting in favor of this 
drainage. 

Pneumatic Treatment. — The spirometer has gained some 
attention recently from the profession in the management of 
phthisis pulmonalis. There is no doubt that the free use of 
the instrument tends to keep the air-cells open, and may in 
the earlier stages of phthisis do much to prevent the occupancy 
of the apices with tuberculous matter. After the deposit has 
occurred there is less to be expected from its use. 

The modification of the Hutchinson spirometer by Prof. 
Waldenberg, of St. Petersburg, Russia, can be used in a man- 
ner to increase the power of both inspiration and expiration, 
and is the best instrument we have. 

Certain arm and shoulder movements facilitate the expan- 
sive capacity of the lungs, and may be practiced somewhat 
upon the principles of the Swedish movement cure, always 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 151 

taking great care not to prolong exercise beyond healthy re- 
action. 



CHAPTER XVII. 
ACUTE PHTHISIS. 



We prefer Niemeyer's classification upon this variety of 
phthisis, and would not confound the disease with rapid de- 
generation and softening of the caseous exudation, which some- 
times occurs in connection with pneumonia and is often termed 
"galloping consumption." In a large per cent, of acute cases 
of phthisis, however, the disease occurs where the lungs have 
old caseous deposits. From this fact the question has natur- 
ally arisen, whether this acute phthisis does not come of some 
pernicious effect which the cheesy deposit exercises upon the 
blood ; but it is not confined to this class of crippled constitu- 
tions wholly, and must arise also from other and unknown 
causes. The tubercular deposit is always of the miliary kind, 
and nearly always exists in a state of crudity. The lungs will 
be found studded from apex to base with these millet-seed 
sized granules ; often the pleura and other organs also becom- 
ing involved. As the lungs may be studded with these gran- 
ules without producing any perceptible dulness, the diagnosis 
is not always easy to make out. It may be confounded with 
pneumonitis, pleuritis, capillary bronchitis, typhus fever, in- 
termittent or typhoid fevers, as w T ell as certain diseases of the 
heart. There are, however, differential points usually, which, 
if carefully studied, will enable one to come to pretty definite 
conclusions. The dyspnoea, the high grade of temperature and 
rapid pulse, are important ; the family history and diathesis 
are also very important. The prognosis is unfavorable; never- 
theless the prompt administration of the true homoeopathic 
remedy should be tried. We may possibly see better results 
than expected. The Apium virus, I believe the best remedy 
we have. In Ferrum, Calcarea phosphorica, Iodine, Phos- 
phorus, Sulphur, Zincum, may sometimes be found a better 



152 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

similimum, and if so no one will hesitate about giving them 
a trial. Most writers speak of the disease as beyond the reach 
of all medication. We do not think the homoeopath is to look 
upon any disease in its inception as outside the limits of pos- 
sible relief. Upon the theory that in acute miliary tuberculo- 
sis we have an acute lymphangitis, we put forward in part 
Apium virus as a probable remedy. The frequency of respi- 
rations as well as the pulse, when compared with the grade of 
fever, seems to have some analogy of symptoms. Raue brings 
forward Arsenicum, Gelsemium and Lachesis, in addition to 
those mentioned ; and in the advanced stage Ammonium carb. 
is suggested, but no indications are given. 

Drs. Wood and Formad, in making experiments upon rab- 
bits by inoculating them with the membranous exudation of 
diphtheria, found that tubercular deposit followed. What the 
significance of this fact may be we are hardly prepared to say. 
The two diseases seem to be of the class presenting the condi- 
tion of hyperfibrinosis. It looks a little as if there were an 
element of propagation here, that fibroid degeneration passed 
over into tubercle, and that the lungs were the seat of the 
morbid product in the rabbit. If it should be determined 
that acute tuberculosis is essentially an active and possibly in- 
fective lymphangitis, it would support by analogy and on theo- 
retical grounds the indications of Apium virus. 



CHAPTER XVIII. 
CHRONIC TUBERCULAR PHTHISIS. 

By this term we mean those cases of consumption which run 
their course in the ordinary way : first, in deposit of caseous 
exudation or by tubercular infiltration ; second, in the soften- 
ing of tubercle and the breaking down of both tubercle and 
the surrounding tissues ; third, in resolution and recovery by 
expectoration, with cicatrization of the walls of cavities, and 
possibly by crystallization and encysting of tubercle, or death 
from exhaustion and the poisonous influence of purulent mat- 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 153 

ter in the circulation. These cases may come to us from all 
the sources discussed in previous chapters and possibly from 
still other sources. 

We have at this juncture albuminous matter either in the 
air-cells and mucous membrane, or in the walls outside of the 
vascular vessels, or both, undergoing the cheesy or fatty trans- 
formation, probably with tendencies also to the production of 
earthy phosphates. Often the surrounding structure becomes 
inflamed and the inflammatory action in the parenchymatous 
structure, is going on as a limited pneumonia where fresh tu- 
bercle may be depositing. 

The apex of the lung is usually the point first attacked and 
will be more completely and heavily loaded down with tuber- 
cle, though frequently considerable extension of the disease to 
other parts of the lung will be found, and cases are not want- 
ing in which a greater portion of both lungs has been loaded 
with this exudation. 

As one lung is primarily affected, and as there are primary 
seats of exudation in the same lung, we will find often all 
stages of advance in the same person, perhaps in the same 
lung. It is no more nor less than an ulcerative process with 
the purulent matters burrowing in the lungs. At this stage 
the bronchi often become loaded down with purulent matter 
from their terminal ends by coughing, and the case may be 
complicated by auto-infection. The cavities may be isolated 
or their may be several communicating with one another. 
They vary much in size, from that of a hazel-nut, or even 
smaller, to cavities occupying large portions of the lung. 

Recent cavities are irregular, with rough and jagged walls; 
later the fibrous tissue is fully dissected out, leaving only the 
more indestructible parts, such as blood-vessels, bronchi and in- 
durated fibrous tissue ; very old cavities are usually lined with 
a smooth membrane. The contents of cavities may be quite 
different, showing the changes purulent matter undergoes from 
the influence of air and the progress of chemical degradation. 
Associated with these cavities we not only have tubercle in 
advancing stages in other portions of the lung, but possibly 
11 



154 PHTHISIS PULMONALISI TUBERCULAR PHTHISIS. 

we may find portions of the lung where the disease is retro- 
grading. 

We may also have pleuritis, and the adhesions may be very 
thick and firm; we may have pneumonitis, bronchitis and 
emphysema, even collapse of the lung, subjects which have 
been fully discussed in previous chapters. 

Errors and Inadequacy of Phthisical Therapeutics. — It 
is astonishing to witness the mental obtuseness which follows 
a training in dogmatic systems of thinking. One would think 
that so great a vitalist as Dr. James Henry Bennett would 
never be guilty of comparing therapeutical action to manuring 
a field, but here are the doctor's own words: "In phthisis 
observation shows that it is judicious to increase the usual 
amount of fat given into the system, and observation seems to 
show that it is equally right to increase the amount of phos- 
phates. Phosphorus is only contained in limited amount in 
our food, although it exists in so large a proportion in our 
system; its administration in a disease of debility may there- 
fore be compared to manuring an exhausted field. If corn is 
grown in succession in the same soil the crop at last fails for 
want of phosphate of lime, which is necessary to form the 
grain. It is in this sense that I give the preparations of phos- 
phorus." Could there be a statement more utterly short of 
indicating true therapeutical action? If the vital powers have 
so far succumbed as to be unable to appropriate the organic 
phosphates found in food, what shall we say of a man's intel- 
lect which conceives that the crude mineral phosphates can 
be shoveled into his patient's stomach to advantage? Phos- 
phorus indeed may be a therapeutic agent, but only by virtue 
of the power it has to provoke the vital forces into movements 
which shall enable transmutation to go forward among mole- 
cules which can thus be made to build and repair structure; 
only by substituting a healthy vital action for a morbid ac- 
tion; only by arresting the progress of retrograde metamor- 
phosis, or degrading chemical action can forward vital move- 
ments take place. Thus the defective elements in old school 
therapeutical management of phthisis is shown upon the very 
threshold of the discussion. This Dr. Bennett who has written 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 155 

a work on consumption and offers his own case as a specimen 
which he claims to be exceptionally well managed, says : " I 
have avoided as much as possible the circumstantial enumera- 
tion of local symptoms, which are much the same in all cases, 
as also the details of treatment. Each case is intended to il- 
lustrate a pathological type or a social phase of pulmonary 
consumption." Now, most likely just that circumstantial enu- 
meration of symptoms must tell us the remedy adapted to the 
case; as each case must be thoroughly individualized in its 
symptomatology, which expresses the sensorial and most im- 
portant side, to add to the pathological side, to meet the de- 
mands of homoeopathy, we see how much more completely 
homoeopathy grasps the subject. As every case is individual, 
so we need to know in what that individuality consists and 
find its correspondence in therapeutical agents. So eminent a 
physician as Prof. Austin Flint has little to offer but hygienic 
treatment, such as consists in change of occupation and good 
air. It is to be hoped that we are entering upon a new era in 
the treatment of this terribly fatal disease. 



CHAPTER XIX. 
APIUM VIRUS. 



Lungs and Thorax. — Soreness in the upper part of the 
chest ; pains are usually in the left thoracic region and opposite 
the middle of the sternum (this suggests sympathy with the 
heart). 

Cough. — Cough provoked by constrictive feeling in the throat 
and by pressure at the sternum. Irritation to cough in the 
supra-sternal fossa. Cough dry, with gagging; with painful 
concussion of the head. Little or no expectoration. 

Aggravations. — After sleeping (Lach.), by lying on left side 
(Lye, Phos.) ; by recumbent posture. 

Accompaniments. — Among the throat symptoms we have 
hoarseness and congestions of the mucous membranes; speak- 
ing is painful ; feels as if wearied in the larynx. The breathing 



156 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

is hurried and difficult, worse from motion, worse in a warm 
room. Patients have a pale, sickly look ; pale and sallow ; 
burning cheeks with cold feet; red face, hot and swollen; 
oedema about the eyes (Kali c.) ; swollen lips ; and lymph glands, 
small and great, inclined to tumefaction. 

Pulse is accelerated ; may be strong, or may be weak ; inter- 
mittent, or wiry and frequent; conditions pointing to an in- 
flammatory action of the vessels. Nervous symptoms are 
trembling, great prostration, tired feeling, restlessness. 

Tuberculous patients are always wishing that they could get 
rested. 

The action of Apium virus on the system frequently pro- 
duces a craving for milk, which relieves. 

The power which Apium has to control glandular enlarge- 
ments and irritations goes to support its claim as a remedy in 
tuberculosis of the lungs ; and we bring it forward confidently 
expecting that it will take high rank among our remedial 
agents in the early stage of tubercular affections of the chest 
organs, as it already has in albuminous exudations in other 
localities. 

That there may be something in this constitutional albumi- 
noid diathesis we quote Dr. Henry Bennett in proof. " Most . 
winters at Mentone, I lose one or more of my consumptive pa- 
tients from Bright's disease." He further says, when in Paris 
he found many of his old associates believing in the curability 
of phthisis, but one and all stated, that many of these cases of 
arrested consumption had subsequently died of some other 
form of cachectic disease, and principally of albuminuria. For 
the cure of albuminuria we regard Apium the most important 
remedy we have. 

For that form of phthisis which declares itself in a general 
lymphangitis especially do we bring forward Apium virus. 

In acute affections of the glands and lymphatics, if we may 
judge by its provings, it must become a leading remedy. 

ARSENICUM ALBUM. 

Lungs and Thorax. — The chest symptoms are usually more 
pronounced upon the right side. We have sharp pains in upper 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 157 

third of right lung. Burning in the chest ; feeling of rawness 
and soreness. Constriction of the chest. Dr. Gregg offers the 
symptom, "burning in the upper portion of the right lung, with 
hemorrhage. 

Cough. — Cough dry and fatiguing. Paroxysmal, violent. 
Sometimes with glairy, frothy, transparent sputum, which 
later in the disease becomes yellow or grayish-yellow. 

Aggravations. — In the morning on rising, or in the evening on 
lying down (Phos.). After drinking. On going into cold open air. 
Worse about midnight. 

Accompaniments. — Face has the bloodless cachexia, well 
stamped, as seen in the waxy, gray, pale, earthy and bluish 
tinges of the skin; the face is also swollen and sometimes 
flushed; but the former is a rare symptom in tuberculosis, un- 
less in connection with fatty degeneration. 

There is much disturbance of the stomach, pains in the re- 
gion of the liver, and engorgement of the spleen ; tenderness 
with burning sensations are quite typical of Arsenicum. 

In the febrile activity we have much shuddering, worse in the 
open air, with little thirst, or if thirst, it is short, calling for only 
a little fluid. 

The chill is often undeveloped, being more internal, often alter- 
nating with flushes of heat ; sometimes chilliness comes several times 
a day, seeming to be of a nervous character, as little heat 
follows. 

Hurried breathing upon moderate exercise, dyspnoea on lying 
down are accompanying symptoms in tuberculosis. Voice is 
weak and trembling; feeling of oppression increased by heavy 
air and stormy weather. For tissue waste with great weakness, 
and disinclination to muscular movements, Arsenicum has a 
correspondence. 

Like Apium it has a very decided action upon the lympha- 
tics, and in plastic exudations is used to awaken absorbent 
activity. 

Its influence is seen upon the nervous centres, especially of 
the organic or vegetative system, upon the blood corpuscles 
and the glands. It seems to increase the power of the system 
in the production of fat, thus being able to correct certain faults 



158 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

of assimilation. Whether this has anything to do with the 
service it renders in consumptive cases, we are unable to say ; 
certain it is, that it is an active agent when used to unload the 
glands, and when wanted to work an excess of fluids from the 
system. It is an anti-hydrogenoid. 

We will report three or four cases of unequivocal character, 
where Arsenicum has proved of service, but would advise that 
it be tried early in the disease and before the tubercular deposit, 
as a means to prevent exudation. 

Clinical. — Case 1. — "Mrs. W., set. 32, of a nervo-bilious tem- 
perament, with dark hair and dark eyes, quite slender, had 
passed two menstrual periods. Was harassed with an irritative 
cough, and had been for some months; dulness of right lung in 
the apex; had hectic fever. The symptom to which we attached 
most importance in selecting a remedy was shuddering without 
thirst, or full development of the chill. This occurred two or 
three times in the twenty-four hours, and was worse when in the 
open air; her expectoration was but slightly purulent, mostly 
of a frothy mucus, though portions were yellow and thick ; 
had night sweats of a cold clammy nature. Gave Arsenicum 200 
with so favorable results that chills were at once arrested and 
resolution was so rapid that she menstruated in eight weeks ; 
became pregnant and miscarried at the third month; flooding 
was serious, and went into a rapid decline, dying of phthisis 
within ten weeks after miscarriage. Her pregnancy shows the 
extent of curative reaction made by the Arsenicum, and her 
death the correctness of the diagnosis." 

Case 2. — " Louis Emmel, set. 34, weighs 120 pounds; a Ger- 
man, pale, hollow-cheeked, blue eyes; a cigar-maker; has been 
in this country two years; ailing ever since; is now so weak 
that he can hardly walk to my office ; coughs, particularly after 
midnight until morning; usually gets no sleep after one o'clock; 
after having coughed a while a disgusting taste of the yellowish- 
green expectoration which is quite profuse; aching, distressing 
pain in the upper right lung ; the pain is worse when coughing ; 
while coughing extreme thirst for cold drinks, particularly cold 
milk, wishing to drink very often, but not much at a time; per- 
spires profusely after midnight; no appetite; soreness in the 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 159 

region of the stomach after eating, and sensitive to extreme 
pressure; bowels at times loose, and then at other times cos- 
tive. Four weeks ago raised several mouthfuls of blood ; half 
of the upper right lung dull on percussion; respiratory murmur 
very trifling in lower part of the lung; gurgling, rattling 
sound under right clavicle as if from a cavity; left lung nor- 
mal ; pulse over 100. Arsenicum 1 " 1 , Fincke, one dose. Five 
days later reports great improvement; can sleep until 3 or 4 
o'clock; much less thirst and some appetite; perspires very 
little ; improved steadily until the 4th of October or about a 
month, when he drank three glasses of beer, after which raised 
sputa streaked with blood ; on this day he got Arsenicum 38111 , 
Fincke, one dose. Oct. 25, reports expectoration diminished 
one-half; no perspiration; sleeps until 5 or 6 o'clock; expecto- 
ration nearly colorless, and has no taste; no pain in the right 
lung; weight increased in a short time to 134 pounds; dulness 
less, and far less rattling in the region of the cavity under the 
right clavicle; his general improvement is so marked that 
there is good reason to believe the lung will gradually mend." 
— Wm. P. Wesselhceft. 

Case 3. — "H. T., set. 28, tall and slender, elongated and nar- 
row chest, subject to sexual excesses, has had a hacking, dry 
cough for several years. In 1870 had an attack of pneumonitis 
of which he was thought to be cured, but was left with a hollow- 
sounding cough, dyspnoea and stitching pain in the chest, fol- 
lowed in a few weeks by a severe hemoptysis. The bleeding was 
troublesome for a week or so ; the cough continued growing 
more and more severe, attended with hectic fever and much 
prostration. Aggravation at night, but coughed both night and 
day ; night sweats ; pale face with red spots on both cheeks ; 
dryness of throat and mouth; ravenous hunger; tormenting 
thirst ; red urine which scalded at micturition ; sometimes long 
retention of urine ; much restlessness day and night ; burning 
in the chest, and shooting pains ; expectoration of fetid, dark, 
greenish solid lumps of matter. Arsenicum album, 3d, 6th 
and 12th trit. cured the case." — Dr. Arndt. 

Case 4. — "A girl, set. 24, of graceful form, was taken with rais- 
ing of blood in the summer of 1857, with well-defined symptoms 



160 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

of tuberculosis, which increased so much by the spring of 1858, 
that the patient was confined to her bed and seemed at death's 
door. She is very much emaciated ; coughs a great deal ; the 
sputum is chunky, yellowish-brown and of disagreeable sweetish 
odor; the left lobe of the lung as far up as the middle of the 
scapula is studded with tubercles ; pulse rapid and small ; 
diarrhoea; has not menstruated for four months. Arsenicum 
restored her to full comfort, brought on a return of menses 
and enabled her to discharge the duties of life." — Eidherr in 
Neue Zeitschrift, IV, 190. 

Dr. N. V. Miller uses Ars. iod. for following symptoms: 
"Soreness in larynx; hoarse, racking cough day and night, 
with profuse purulent expectoration." 

BAPTISIA TINCTORIA. 

Lungs and Thorax. — There is a feeling of tightness upon 
the lungs ; hardly able to get a full breath. Right lung more 
pointedly impressed, often sore. 

Cough. — Comes from tickling in the throat; frequently from 
elongation of the uvula. 

Aggravations. — On waking at 3 a.m. (Kali c), 11 a.m. 

Accompaniments. — One awakes with difficulty of breath- 
ing ; has to have the windows open and get the face to fresh 
air (Carbo. veg.). We have hoarseness and aphonia ; increased 
secretion of the bronchial tubes and fauces. 

Dr. C. C. Smith gives as a key-note for its use for tubercu- 
lous patients, "chill every morning at 11 o'clock, and fever 
each afternoon." Additional symptoms are : chilly over the 
back while sitting at the fire; feet cold with other extremities hot; 
awakes at 3 A.M., with flushes of heat as if perspiration would start. 

Dr. J. S. Mitchell recommends it for: "Chill in the forenoon 
or afternoon, followed by heat and perspiration as in ague : general 
weakness and languor ; sometimes loss of hopefulness." Bap- 
tisia is adapted to many symptoms which find expression in 
the tubular passages, and may be used to ameliorate some 
cases of phthisis, but hardly meets any cachexia. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 161 

CALCAREA CARBONICA. 

Lungs and Thorax. — Sore pains in the lungs felt more by 
deep inspirations, and stitches when moving. Stitches in both sides 
of chest aggravated by leaning forward. Sharp, slow stitches in 
left side of chest, in a line horizontal with the pit of the stomach. 
Stitches in the chest from the left to the right side with sense of 
constriction. 

Stitches mostly begin on left side. 

Sharp stitches in right thorax, from within ontward, not affected 
by breathing as most Calcarea pains are. 

Cough. — The cough is dry, especially at night, often violent, 
and when expectoration follows, the feeling is as if something 
had been torn loose, Cough is provoked by air carried down by 
full inspirations ; and by tickling in the throat as from feather- 
down ; also by eating, and playing on the piano. 

Aggravations. — Morning and evening. 

Accompaniments. — Morning exhaustion; dozing even after 
getting upon the feet. Intense melancholy. Very forgetful. If 
patient be a woman still menstruating, menses too early, too 
profuse, too long lasting. 

Face chalky colored, pale, may be bloated or may be thin; 
if thin skin inclines to shrivel. 

Flesh often flabby and soft. Lips swollen. Eyes surrounded 
with blue rings. 

Neck is slender and head seems too heavy for the small size 
of the muscles. 

Derangements of the stomach, such as a sense of weight soon 
after eating; pressure at the pit, which is distended, eructations 
which are tasteless or sour ; spitting up of food or vomiting of in- 
gesta; rapid loss of flesh (Iodine). Abdomen bloated; mesen- 
teric glands swollen, and various peculiarities in the excreta; 
such as, hard at first, then thin, offensive and clay-like or chalky 
stools, with inclination to prolapsus recti. 

We have painless morning hoarseness; aphonia, desire for 
deep inspirations and shortness of breath with vertigo, especi- 
ally when ascending stairs or going up hill. Stitches in left 
mamma when coughing. Stitches in Calc. carb. about as 



162 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

marked as in Kali carb. Dr. Gregg gives : " Pain in the 
upper half of right lung (Ars.). Cough with purulent sputa* 
worse in the morning on rising, and in the early evening, with 
paroxysms during the day, less during the night. Loud breath- 
ing through the nose, bleeding from right nostril." 

Dr. Fellger gives us the symptom: "Expectoration falls to 
the bottom in water, with a trail of tough mucus behind like a fall- 
ing star." 

Dr. C. C. Smith: "Whole chest intensely painful to touch." 

Calcarea is a very important remedy in arresting tubercular 
deposits and in keeping them latent after being deposited. It 
is well adapted to disorders connected with faults of secondary 
assimilation. With such defects there exists a tendency to 
hypertrophy of the lymphatic glands, and obstructions in the 
lymphatic vessels. It is often of more importance to correct a 
constitutional tendency than to exert one's self to overcome a 
difficulty which has asserted its full force. Our efforts in the 
one case may be entirely successful, whereas, in the other we 
make little headway. It is the constitutional tendency which 
should always be attended to in these cases, and Calcarea is 
among our most important constitutional remedies. 

Clinical. — Case 1. — Mary Foster, set. 4, with blue eyes, large 
head, and small muscles, does not seem to grow well ; eats little 
and is very nervous. Tires out easily. Upper lip a little swollen, 
teeth very white. Inclined to diarrhoea, undigested food passing 
with the excreta. Tendency to curvature of the spine. To look 
at her seems as if her neck were too small to carry so much head. 
Flat chest and wing-like shoulders. Gave Calcarea 6th attenua- 
tion with a quick response, and advance of nutritive move- 
ments which resulted in firm health and in giving general har- 
mony to the structural development in the course of two years. 
— G. N. B. 

Case 2. — Frank W., a lad set. 10, blue eyes, light, thin hair, 
pale, thin face and of a scrofulous disposition. One year pre- 
vious to my call a periostitis set up in the shaft of the left 
tibia upon the inner side. Case as presented to me the first 
time : bone has exfoliated along the whole length of the shaft ; 
ulcer is so deep that not more than one-half of the supporting 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 163 

structure remains and leg is much bent; ulcer keeps up a con- 
tinuous discharge which has left little vital resource behind. 
Patient is not only badly emaciated, but has a hectic fever and a 
bad cough with dulness in the right apex. Cough is dry and 
harasses him in the evening; has night sweats. Was given 
Calcarea carbonica 6 , and urged to use milk freely as a diet, 
to which was added the amount of three tablespoonfuls of 
brandy every twenty-four hours. Ulcers were fully healed 
and bone reparation complete within the next twelve months. 
All traces of lung trouble also passed away and I have never 
known of subsequent trouble, though case passed from my ob- 
servation in the course of half a dozen years. We will here 
add that we have many times succeeded in curing these bone 
ulcers, commonly called "fever sores," with the use of Calcarea 
carbonica, milk and brandy, and they all remain cured so far 
as we know. — G. N. B. 

Case 3. — J. Hall, set. about 14, of a scrofulous lymphatic tem- 
perament ; mother died of tubercular phthisis four years after 
case reported convalesced. When consulted found patient with 
a bad cough and rapid respirations, accompanied with an irri- 
tative fever. Percussion showed extensive dnlness through apex 
of left lung and down to fourth rib; fever increased notwith- 
standing remedies and soon assumed the hectic character. A 
large cavity, really an abscess, formed, and fortunately was 
sufficiently anterior and near enough to the surface of the 
lung to point at the left nipple where it was opened. The 
abscess communicated with the large bronchus also, as puru- 
lent matters were expectorated through the broncho-tracheal 
passages. It seemed a gallon or more of purulent matter 
passed away in the next six months through opening at the 
nipple ; purulent expectoration continuing also at the same 
time from the mouth. Patient took Calcarea carbonica and 
was well fed, and given a little brandy and milk four or five 
times a day and made a recovery in the course of the year. 
Cure attributable not a little, probably, to good drainage. — G. 
N. B. 

Case 4. — Mr. K., a young man, set. about 21, family decidedly 
consumptive ; slender built, of a waxy, pale complexion, auburn 



164 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

hair and blue eyes. Troubled with a severe cough of a dry 
character, worse at night; sometimes stitches in the chest and 
inclined to diarrhoea of a liquid nature and mixed with indiges- 
tible substances ; bowels a little prominent and tender. Diag- 
nosis : tubercle in mesenteric glands and parenchyma of the 
lungs. Gave Calcarea carbonica 30 . General improvement com- 
menced and continued for some time ; patient continued his 
work, which was that of a train express man ; gained flesh and 
strength, though the cough did not altogether disappear; took 
a fresh cold, quit work and very soon active hectic symptoms 
set in and patient went to another part of the State to die 
among friends. The value of the case is in showing that for a 
season advance of tuberculosis and degradation of tubercle 
were arrested by Calcarea. Termination of the case showed 
tubercular affection of both the mesenteric glands and the 
lungs. Whether under better management case could have 
been pushed to complete curative results is the question to 
raise. We would now give higher potencies of Calcarea car- 
bonica for a similar case and try to obviate aggravations from 
catarrhal attacks. The value of Calcarea in scrofulous swell- 
ings is fully admitted and suggests its value in tuberculosis. 
In faulty assimilation and chronic diarrhoea as well as in col- 
liquative sweats, it covers many symptoms that accompany 
pulmonary tuberculosis and tuberculosis of the mesenteric 
glands. In glandular enlargements, scrofulous ulcers and the 
gravest forms of catarrhs, we have accomplished all we could 
ask.— G. N. B. 

Case 5. — Mrs. B. of a scrofulous constitution through paternal 
side; of sanguine nervous temperament, auburn hair and dark 
eyes. Grandmother, father and two sisters had goitre; one 
sister died of tubercular phthisis of the lungs, showing no sign 
of goitre, nor did the present subject; grandmother always 
troubled with a cough, though she lived to old age ; consump- 
tion still more common in other branches of father's family ; 
patient had whooping-cough when a child from which she 
recovered with difficulty and was always subject to a harassing 
cough of a dry provoking character; after her marriage was 
somewhat better, but after bearing her second child she showed 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 165 

evident signs of decline, losing strength and flesh for six weeks 
with cough, growing steadily worse. At this time she took 
Arsenicum 30 , being led to it by peculiar numb sensations in 
the upper extremities, soreness and pain in apex of right lung, 
the cough being worse immediately after lying down, accom- 
panied with titillation in the larynx. She soon improved and 
got on very well till the next spring, when she was taken down 
again ; this time she was tried on her old remedy, but to no 
purpose, but Calcarea 30 did arrest the cough and other symp- 
toms which were as will be seen more conformable to its path- 
ogenesis. 

Cough was very dry and harassing morning and evening, espe- 
cially with tickling as from feather-dust in the throat ; if any 
sputum was thrown off it seemed as if it had to be torn from 
the larynx ; tongue would often protrude from the mouth so violent 
was the cough, and with such difficulty was anything detached. 
Calcarea carb. had the effect to finally control the worst of 
these symptoms and restore patient to her usual health. 

The old cough, however, never quite left her for any con- 
siderable time, and was always worse from a little exposure. 
This lady, however, managed to live and raise a family of 
three children, besides losing two in infancy. When she 
reached her climaxis she died of a tubercular affection of the 
left lung. Her three children showed signs at puberty of hav- 
ing enlargement of the thyroid. 

Her first born had a prominent thyroid at puberty, arrested 
by Calcarea and the Iodide of mercury. Later, ozoena, cured 
by Sepia and Aurum. The younger child, a son, showed 
struma in childhood, having a fiery redness upon the tip of 
nose, glandular cervical swellings, enlargement of thyroid at 
puberty, and loss of teeth before fairly advanced from youth. 
Calcarea has been an important remedy in keeping back the 
more pronounced progress of the hereditary cachexia. One 
member has been benefited by cod-liver oil. Perhaps Iodine 
would have served well in this family. Iodide of mercury did 
discuss a thyroid enlargement in the case of a sister of the 
above-mentioned patient. — G. N. B. 

We transcribe the salient points of a case reported by J. P. 
Geppert, M.D., in the Medical Advance, of Dec. 1881. 



166 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Case 6. — During the fore part of June, 1880, was consulted 
by the mother of patient concerning a case of tubercular 
phthisis. The patient was a young, single man, set. 22; much 
emaciated; pulse accelerated, and temperature raised above 
normal; hectic fever; night sweats; both lungs showing evi- 
dence of serious lesion. Case at time was under charge of a 
prominent old school physician in this city (Cincinnati), and 
had been for months past. 

His prognosis was death within a month, and I have no 
doubt the prognosis would have proved true had the same 
treatment been continued. The family history on the mother's 
side was fair ; that on the father's side was exceedingly un- 
favorable. The parents of the father had been induced to 
place their son in a mercantile house, and proper precau- 
tions had not been taken to prevent the development of con- 
sumption, due to confined life, or the breathing of an atmos- 
phere deficient in oxygen. The father died shortly after the 
birth of the patient (patient being about two years old at the 
time of father's death) of consumption, leaving three children. 
The eldest was a daughter who died of consumption during 
the middle of the year 1878. The second child, a son, is now 
living, but troubled with a cough. He is reluctant to receive 
any medical treatment or examination, therefore am not able 
to speak more definitely concerning him. 

Observation teaches us that the last children of individuals 
affected with such diseases as consumption in their progressive 
development, should show their hereditary effects strongest. 
This we see in the case of the sons, and there is no doubt it 
would have been the case with the daughter, but for her 
changed environment as compared with the sons. The daugh- 
ter was very domestic, seldom going from the city and gen- 
erally remaining in the house, thus favoring the development 
of such hereditary predisposition. 

From this history we see the unfavorable position the pa- 
tient was in, and would not unreasonably expect such a per- 
son to die without special relief by the ordinary therapeutics. 
During June, the patient was under my care and received 
principally Phosphorus, 30th centesimal potency. One or two 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 167 

other remedies were given for special symptoms that presented, 
but only for a few days. From the bed-ridden condition in 
which I found the patient, he shortly improved so as to go 
upon the street, and asked m} r advice concerning a trip to 
another state, that he might visit friends and relatives, and 
secure a change such as that of atmosphere, food and associates. 
Knowing that the change would be that from a crowded city 
with abundance of smoke and an atmosphere containing a 
high percentage of carbon dioxide, like that of Cincinnati, to 
the advantages possessed by a country habitation, I favored 
the suggestion and gave him Phos. 30 , to be taken every second 
day, with instructions to write me soon after his arrival and 
with the expectation of continuing the treatment. Like other 
expectations, however, this one was not realized continuously. 
Being distant from the patient there was lost that influence 
which the personal presence of the physician exerts on the pa- 
tient when the individual is properly adapted to perform the 
office of healer of the afflicted. The patient passed into the 
hands of a local celebrity for the treatment of consumption, 
whose prescriptions contained ounces of Oleum terebinthinse, 
irritating local applications, and the indulgence of a quantity 
of fresh drawn blood of animals daily as food. Under this 
troublesome, disgusting treatment he did not improve, but 
soon returned to his former low state, and home. It did not 
take more than two months of such treatment to overcome all 
the good derived from his short homoeopathic treatment. 

One Sunday night while at church I was sent for at my 
office. The message left was for me to call that evening and 
see the patient, not that I could benefit the patient any, as he 
would die before morning, but that his distant friends and 
relatives might feel that all was done that could be done for 
him. I called and found the patient moaning and suffering 
greatly. I prescribed for him and promised to return in the 
morning. The home relatives telegraphed to distant relatives 
that he was dying. At my second visit I found my patient 
more comfortable. 

From my general observation I was of the opinion that low 
potencies and alternation would not prevent the patient dying 



168 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

soon. I had had a number of cases in somewhat better con- 
dition die under the administration of low potencies, and de- 
parted from my general practice, feeling that a change and 
trial of the higher potencies could not be injurious, and were 
they as beneficial as represented, good only could come of the 
change. 

I was, during my first years, only acquainted with the allo- 
pathic method of practicing, but circumstances placed me in 
such a position as to receive my medical education in a 
homoeopathic college. I was therefore a member of the low 
potency division or class of our school. The much repeated 
mathematical demonstrations to prove the absence of any 
quantity of medicines in the higher potencies sufficient to pro- 
duce therapeutic effect, was early presented to me, and even 
exerted an influence upon me after the time our relatives in 
the Northwest threatened destruction to high potency views 
with the weapons of allopathy, under the title of the Milwau- 
kee Test. I, too, was taken by the efforts on paper to demon- 
strate that good results were only psychological and not due 
to the medicine when administered by high potency men. I 
came into practice a low potency individual, and previous 
habit and instruction have prepared the lines of least resist- 
ance in the direction that leads to the administration of low 
potencies. Like an imperfect wheel, or one not properly cen- 
tered, which produces erratic motions while revolving, I may 
not be able to avoid the errors which my organic develop- 
ment forces me to pursue when active. The mind of man is a 
growth and requires as much training as any other organism 
for its proper structure. 

This patient was put upon Calcarea carb., and during 
months it was the only remed} T employed. He received at the 
beginning Cal. carb. 30th for some time, then the 200th, after- 
ward the 1000th potency, and the last Calcarea carb. adminis- 
tered was Fincke's 107,000 potency. Medicine was given him 
at long intervals, sometimes only a single dose a week or fort- 
night. As some other indications than those for Calc. carb. 
presented after a long use of Calc. carb., a few doses were given. 
The improvement in this case was truly gratifying on the ad- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 169 

ministration of the highly potentized remedies. Other equally 
satisfactory experience I can recall." — J. P. Geppert. 

Case 7. — A case from Dr. Arndt presents much interest: 
" Mrs. E. G., set. 36, had been given up to die by her family phy- 
sician. She came of a consumptive family, her mother and her 
mother's parents having died with the disease. She had always 
menstruated very profusely, and after having produced upon 
herself, within the course of eight or nine years, no less than 
seven abortions, her menses assumed the type of recurrent 
hemorrhages. Her lungs had always been very sensitive ; has 
had more or less cough, at first dry and hacking, later loose and 
hollow. Has had pneumonia twice, making a very tardy re- 
covery each time. 

"At present was convalescing from a third and severe attack 
of pneumonia, when some imprudence on her part brought 
about an unfavorable change, and she failed so rapidly that 
her case seemed hopeless. 

"Symptoms: constant hollow, loose cough ; extreme sensitive- 
ness of the lungs to cold air, and to a jar; profuse and general per- 
spiration at night, of a sour smell. Extreme emaciation ; consti- 
pation alternating with watery diarrhoea; great despondency; 
constant passive hemorrhage from the uterus of dark, foul blood. 

" Calcarea carbonica 30 was the first and only remedy pre- 
scribed. Under its use she not only made a good recovery from 
this attack, but regained by its long-continued use a surprising 
degree of general health." — H. R. Arndt, M.D. 

Case 8. — "Mrs. F. H. A., set. 23, tall, large, of fair complexion 
and of lymphatic temperament, mother of one child, herself 
the only child of a mother who died of phthisis at the age of 
twenty-seven years. Mrs. A., when a child, was very sensitive to 
changes of weather, and spending the greater part of her child- 
hood in travel and in boarding-houses, suffered frequently 
from colds, with dry, hacking cough and hoarseness. At the 
age of twelve years she went to live in one of the Southern 
States. Commenced to menstruate at the age of thirteen ; 
menses fairly regular, normal, but quite profuse. When fifteen 
years old she suffered from a milky, copious leucorrhcea, ac- 
companied with great weariness. Soon after, her appetite be- 
12 



170 PHTHISIS PULMONALIS :■ TUBERCULAR PHTHISIS. 

came fitful, and, eventually, she was placed under medical 
treatment for dyspepsia and a chronic diarrhoea characterized 
by very frequent, watery stools of foul odor, with marked pros- 
tration and general emaciation. At the age of nineteen she 
commenced to improve, and when she married, some two or 
three years later, she had become a large, finely-formed woman, 
seemingly in the enjoyment of excellent health. She bore one 
child; labor was normal; recovery somewhat retarded on ac- 
count of her husband's failure in business. While nursing 
her child, she experienced great exhaustion ; considerable ner- 
vousness, dull frontal headache, palpitation of the heart, a 
tendency to cold, clammy perspiration, flying, stitching pains 
and feeling of weakness in the upper chest, hacking cough, 
without or with scanty expectoration, leucorrhcea, backache 
and a tendency to moodiness. She improved somewhat after 
weaning the child, but continued to cough more or less, failed 
to regain her former cheerfulness, continued to lose flesh, and 
experienced a complete loss of all sexual desire, bordering, at 
times, upon aversion. Six months ago she ceased to menstruate. 

Condition of the patient at the first examination: she ap- 
pears gaunt, hollow-eyed, greatly emaciated; she coughs little, 
but complains of stitching pains in the upper chest; loss of appe- , 
tite; constipation; fluttering of the heart upon the slightest 
exertion ; is weary of life, and but for her love of husband and 
child would welcome death. Constant coldness and dampness of 
the feet; tongue covered with a thick, white, pasty coating; bad 
taste in the mouth; full, heavy, stupid feeling in the head, 
particularly in the morning; pulse 90. Examination of the 
chest revealed a remarkable degree of emaciation, the breasts 
consisting of elongated, dependent folds of flabby skin, and 
the intercostal spaces showing like deep, distinct hollows; flat- 
ness and narrowness of the chest, with hollowness in the sub- 
clavicular region; dulness in the upper chest to percussion; 
number of inspirations per minute but slightly increased in 
frequency. 

Frankly acknowledging her bad family history, the patient 
expressed her conviction that her chief troubles were of uterine 
origin, and that she was absolutely free from tendency to 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 171 

phthisis. In view of the entire history of the case she received 
Calcarea carbonica 30 , one dose every three hours. After taking 
a few doses of the remedy, a violent diarrhoea appeared, pos- 
sessing all the characteristics of a Calcarea diarrhoea. On the 
third day she menstruated normally. 

I heard nothing from the patient until some six weeks later; 
her husband reported marked changes in his wife's condition ; 
she felt better in many respects ; she had commenced to gain 
flesh; showed some sexual desire and her breasts were rapidly 
assuming their former plumpness. But she had again passed 
by her menstrual period. Gave Calcarea in the 200th dilution. 
Again menstruation appeared within a few days. 

The result of the prescription may be condensed as follows : 
menstruation became regular, leucorrhcea disappeared, appetite 
and digestion became normal, pains in the chest subsided, and 
with it nearly all former symptoms of lung trouble ; coldness 
and dampness of the feet no longer troubled her; she enjoyed 
life once more, became pregnant, and in due time gave birth 
to a pair of healthy children. 

The case is remarkable only in two respects: 1. It is an 
almost typical Calcarea case. The remedy was so clearly in- 
dicated in the totality of all her symptoms, dating back to the 
days of her early childhood, that the merest tyro in medicine 
would have recognized it ; 2. The curative effect of the remedy 
was so remarkable in its promptness, and showed itself so plainly 
in every part of her organism, that it makes the case worthy 
of at least passing notice." — H. R. Arndt. 

CALCAREA PHOSPHORICA. 

Lungs and Thorax. — Aching pain, with soreness of chest to 
the touch. Pains on the right side located at the sixth rib; 
shift to the left side, locating a little higher up. Sore pain about 
the sternum and clavicle. Contraction of the chest, with difficult 
breathing. 

Cough. — Cough with hoarseness afflicting patient day and 
night; cough with soreness and dryness of the throat. Cough 
with yellow expectoration, more in the morning. 

Accompaniments. --Face is pale, sallow, yellowish or earthy ; 



172 PHTHISIS PULMONALIS : TUBEKCULAE, PHTHISIS. 

often has a pimply eruption ; cold sweat appears on the face and 
coldness of the body is a prominent symptom (Sil.). Nervous 
symptoms are : "weakness, languor, weariness on going up stairs, 
has to sit down from exhaustion and shortness of breath. Asso- 
ciated with these symptoms we not unfrequently have diarrhoea 
and leucorrhoea. Among the anal symptoms itching hemorrhoids, 
and small furuncles near the anus. 

Symptoms of the larynx are : frequent hawking to clear the 
voice ; breathing is short ; sighs involuntarily. Calcarea phos- 
phorica has proved a valuable remedy in chest difficulties, 
associated with fistula in ano. It corresponds pointedly to that 
class of cases where faults of secondary assimilation exist, and 
where the dyscrasia has a tendency to involve osseous and 
dermoid tissues, especially if hemorrhoids exist, and if sinuses 
form about the outlet of the great cloachus, the indications are 
strengthened. 

It has less of the true albuminoid diathesis than is presented 
in Apium, but in the faulty workings of the functions of the 
excretory organs, and the separating process that preserves 
living structures from degradation by associating with the 
effete, Calcarea phosphorica is an agent of high rank. 

It thoroughly meets the diathesis which is the parent of 
rachitis and tabes mesenterica. There may be presented occa- 
sionally doubts as between the use of the phosphate and car- 
bonate of lime, as there are many analogies, and they actually 
meet a similar dyscrasia. I should think the phosphate usu- 
ally a better similimum for acute affections of the lungs than 
the carbonate. 

Also to cases arising from an old pneumonia to which case- 
ous degeneration is added, and to guard against such a turn 
of the disease. We think Calcarea phosphorica in its relations 
to pulmonary phthisis will hardly be the similimum in so 
large a number of cases as Sulphur, but will supplement Phos- 
phorus often to great advantage. 

It occupies a ground between Calcarea carbonica and Phos- 
phorus. The similarity of action between this drug and 
Tuberculinum, we should expect to be quite marked if not 
identical; yet from my own observation I should decide they 
were not identical in curative reaction. 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 173 

The hypophosphates which have been presented with such 
claims by certain physicians no doubt owe whatever merit 
they may have to this agent ; but in quite too crude a form to 
accomplish that which might be with the homoeopathically 
prepared drug carried well up in dilution or trituration. 

CARBO VEGETABILIS. 

Lungs and Thorax. — Deep stitch in right lung from without 
inwards; stitches in the upper part of the left side of the chest 
after coughing ; aching in the upper part of the right side of the 
chest, at times attended with burning as of red hot coals ; aching 
from right apex through to scapula. (Left, Myrtis and Sulph.) 
Sensation of weakness and fatigue of the chest. Dunham 
mentions the symptom, "breath is short and chest tired on 
waking." 

Cough. — Cough after the slightest cold ; in the morning when 
rising from bed, or when leaving a warm room and entering a cold 
one; short cough in the evening; cough causing vomiting and 
retching in the evening ; violent cough with discharge of a quantity 
of yellowish pus, accompanied by stitches in the left hypochondrium 
when breathing (right, Kali carb.). Raue gives, " cough in hard 
spells not ceasing until masses of offensive sputa are expecto- 
rated." 

Often there is cough accompanied with stitches in the head. 

Accompaniments. — Feeling the want of air and need of a fan 
is quite characteristic. 

Raue gives, "nose-bleed in the night; hoarseness in the evening." 
Hering gives, "hectic fever; exhaustive night sweats; sweat 
profuse, putrid or sour; sallow complexion and sunken fea- 
tures ; vital forces nearly exhausted. 

Dr. Berridge gives as characteristic symptoms, "cough 
worse by day and in the open air; also coughs worse during sup- 
per; soreness of the chest and heat of the body when coughing; 
sensation at night as if choking from mucus in the throat when 
coughing; the choking alleviated by sitting up or moving; itch- 
ing in throat extending to chest, worse when coughing." 

Noack and Trinks say, "Adapted to persons of excessive sen- 
sibility to change of temperature; to cachectic individuals whose 



174 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

vital powers have become weakened ; to gangrene of the lungs ; 
to pulmonary phthisis passing from the stage of inflammation 
to that of suppuration of the lungs ; to incipient tubercular 
phthisis with tuberculous discharge ; to stitches in the chest 
and short breathing." 

Dr. C. C. Smith sends me these guiding symptoms for Carbo 
vegetabilis : " Frequent and easy epistaxis, generally worse night 
or forenoon, followed by pain over chest and pale face ; hoarse- 
ness each evening at 5 o'clock." 

There have been many statistical tables brought forward to 
show that laborers in anthracite coal mines have an immu- 
nity from tubercular affections of the lungs. Mines in Eng- 
land, France, Belgium, North America and others, have fur- 
nished tables tending to show that coal-miners as a class are 
largely protected from phthisis. Such being the fact there 
must be a reason for the same. Different theories have been 
put forward to explain this immunity, such as equability of 
temperature, the presence of the bromides and iodides in small 
proportions in the coal, and even the increased pressure of the 
atmosphere has been adduced as the cause. It is not proba- 
ble that any of these reasons give any important part of the 
solution to the question. It is well known that carbon has a 
power to arrest the processes of transformation going on in 
what is called the putrefactive fermentation. Presumably the 
solution of the question will be found to be in some influence 
upon molecular movements of the microscopical particles in- 
haled, if such immunity exists. The leading elements out of 
which albumen is produced (the chief constituent of tubercle) 
is carbon. Whether there be a law that matter of the same 
kind upon one plane can be used to arrest degrading trans- 
formations upon another plane, is a pertinent question to ask 
here, and I think we shall answer it in the affirmative. Molecu- 
lar energy passes from one molecule to another, aiding its 
movements and transformations when proceeding under or- 
ganic laws, else how are we to explain the phenomena of like 
allying with like, also fermentation and catalytic action. I 
was once called to see a lady with a calcareous impaction of 
the ileum. We were unable to decide what the tumor was, 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 175 

but she had a chalky colored diarrhoea, and a few other symp- 
toms which led us to give her the 200th of Calcarea carbonica. 
She soon discharged large quantities of cretaceous matter from 
the bowels, and the tumor was gone. Be the explanation what 
it may, there is no doubt that Carbo vegetabilis has been of 
service in some forms of pulmonary phthisis. Dunham speaks 
of its applicability to cases of suspected slow tuberculosis, depres- 
sion not preceded by erethism or excitement. 

In bronchiectasis, where the cavities are holding fetid and 
decomposing matters, we should naturally look to Carbo vege- 
tabilis to ameliorate the condition. 

Some of our physicians speak well of a weak spray of car- 
bolic acid in the first stages of phthisis. 

Clinical. — Case 1. — A young man, set. 17, who had for- 
merly suffered from herpes, experienced an exhausting cough, 
with steady, continuous pain in the chest of three or four 
month's standing. He is obliged to cough long and hard un- 
til he raises; expectoration consists of chunks of thick, green- 
ish, fetid, purulent matter; especially copious in the morning; 
loss of appetite; loathing of meat and salty food, and at times 
vomiting in the morning ; difficulty of breathing when walk- 
ing; general emaciation and prostration ; profuse night sweats. 
Cured by repeated doses of Carbo vegetabilis." — Knorre, in 
Allg. Horn. Zeitg., V., 185. 

Dr. McLaren reports his trial of Petroleum, which is a car- 
bonaceous product, in phthisis, in the June number of the 
Homoeopath, which I transcribe : " During my temporary resi- 
dence in New England many opportunities were afforded me 
for the study of pulmonary diseases. My attention was called 
to the above drug by a very intelligent gentleman from the 
oil regions of Pennsylvania, who reported several pronounced 
cases of phthisis in the first stage as having been cured by it. 
He also informed me that the families of those living in that 
region very seldom consulted a physician for any throat ail- 
ment, as they found prompt relief in the external application 
of the drug ; also diluted as a gargle. From these statements 
I was led to use it in phthisis, with the following results : 

"Case 2. — This case was one of incipient phthisis; respira- 



176 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

tion was broncho-vesicular; marked increased vocal resonance; 
night sweats; dyspnoea; poor appetite; pulse, 112. Having a 
preference for the sixth dilution, I prescribed Petroleum 61 . 
There was no improvement until the second week. The pa- 
tient was discharged cured at the end of three months. 

" Case 3. — A young woman, an operative in a cotton cloth 
manufactory, whose parents and only brother had died of 
phthisis, consulted me as the last hope. Jerking respiration ; 
coarse bubbling rales ; broncophony and whispering bronco- 
phony ; pronounced cough, with muco-purulent respiration ; 
pulse, 118; dyspnoea severe; almost total loss of appetite. 
This case seemed hopeless, but I determined to see how much 
virtue there was in Petroleum. The record of my case does 
not state what decided my preference for the third potency. 
Lung exercise, diet and all usual auxiliaries were enjoined. 
At the end of a week my patient was losing ground. I pre- 
scribed the 12x, and continued it for two weeks without any 
hopeful results. I decided to alternate with Calc. phos. 3x , and 
at the end of a week there was evident amelioration of all the 
active symptoms. This treatment was continued for four 
months, and the patient was so much improved as to be able 
to walk a mile every day. I know of no remedy which so 
promptly lowers the pulse and at the same time modifies the 
cough." 

CAUSTICUM. 

Lungs and Thorax. — Soreness in the chest. Tightness of 
the chest, must frequently take a long breath. Stitching in ster- 
num at deep inspiration, and when lifting; stitches deep in chest 
going to back; stitches near the nipple going down toward um- 
bilicus when breathing; stitch during expiration, connected with 
one in left shoulder-joint. 

In the later stages of the disease: loud rales when coughing; 
shortness of breath when walking in open air. 

Cough. — Troublesome, dry ; comes on after getting warm when 
one has been in the cold air. Concussive action of cough causes in- 
voluntary passage of urine. Expectoration in the later stages of 
a heavy creamy consistence, whitish in color. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 177 

Aggravations. — In the open air and early in the morning. 

Ameliorations. — Cough often relieved by a swallow of cold 
water. 

Accompaniments. — Causticum patients are subject to cold 
feet; have a tendency to perspire when walking in the open air; 
have a great deal of internal chilliness; sweating and chilliness 
frequently alternate. Voice is weak and hoarse; tendency to 
hacking and scraping of the throat, especially in the morning; 
rough feeling in throat; also tickling and crawling sensations; 
breath is short on walking. Complexion sickly and yellowish 
pale. 

Psychological symptoms are: easily vexed; inclination to feel 
offended; whining and complaining ; great nervous irritability ; 
full of apprehensions; absent-mindedness; weakness of memory; 
and possibly suicidal tendencies; disgusted with the idea of 
wasting away with consumption. 

Dr. Dunham places much stress upon the hoarseness and 
aphonia: " Hoarseness toward evening with a dry tickling cough ; 
the prover feels a sensation as if he could not cough low enough 
to start the mucus ; rawness and tickling are felt in the throat- 
pit ; patient inclined to backache, especially in the coccyx." 

From the well proven affinity that Causticum has to tracheal 
and laryngeal membranes, its chief value in respiratory affec- 
tions has been thought to be in aphonia and catarrhal troubles. 
The laryngeal phthisis, which authors have mentioned as cured 
by it, has really been considered ulcerative bronchitis, not of 
the tubercular habit. Although these cases are undoubtedly 
for the most catarrhal at the beginning, we are not so sure but 
that we have caseous exudation in the end. We are pretty 
well convinced that we have had cases of this character ; in 
one case the disease was arrested for two or three years, then 
tuberculosis carried our patient off in other hands. We should 
place the chief value of Causticum in cases where an old ca- 
tarrh was progressing downward upon the lungs. Such is the 
course of many of our cases of pulmonary consumption. Tu- 
bercle does not invade the lung tissue proper for a long time, 
but the mucous tissue ; later caseous exudation in the apices. 

Clinical. — Case 1. A lady past fifty years, subject to a chronic 



178 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

cough, was prostrated by taking a severe cold ; had been af- 
flicted with nasal and bronchial catarrh for many years. Com- 
plexion was of a dingy earthy hue ; voice altered by obstruc- 
tions and thickening of nasal passages ; voice rather husky ; 
she was impatient and irritable in disposition. Following her 
acute attack which prostrated her to the bed with considerable 
fever, was a severe cough of a hollow sounding character ac- 
companied with a heavy white muco-purulent sputum, coming 
away in heavy masses. Fever partook of a hectic character 
with night sweats. Patient was easily affected by changes of 
temperature ; could not bear the heat of the fire. Cough was 
ameliorated by taking a little cold water. Bronchial sounds 
were heard under the right clavicle. There was dulness at the 
supra and infra-clavicular spaces. Case was so far benefited 
by Causticum that patient was up and about her family duties 
for four years ; was then taken down and being attended by 
an old school physician, we know little further, save that she 
died with what was called consumption. — G. N. B. 

Case 2. Dr. Berridge mentions a case of catarrh where the 
cough was worse nights and in a warm room, and better by 
drinking cold water, cough accompanied with smarting in 
chest, cured by Causticum. 

Case 3. A good typical case came into our hands in the 
earlier years of our practice. A lady, set. 35, had been for 
some years subject to catarrhal troubles. She was of slender 
make, pale complexion with a little redness about the nose as 
if she might have an eruption ; scanty menstruation appearing 
only in the daytime ; had complete aphonia which had lasted 
six weeks. Much shortness of breath, with a hollow dry cough, 
worse nights and mornings ; cough aggravated by breathing cold 
air, but relieved by drinking cold water. Gave Causticum, voice 
returned in two weeks, other symptoms mending to correspond. 
She recovered so as to enjoy her former health. Living at a 
distance she was not my patient beyond the few weeks re- 
quired to establish her health sufficiently to return to her 
family and its duties. She died of consumption five or six 
years later in allopathic hands. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 179 

CONIUM MACULATUM. 

Lungs and Thorax. — Patient feels as if chest did not expand 
enough, so finds it difficult to take full inspirations. Tightness 
across the chest; short panting breath; pleuritic stitches; rat- 
tling in the chest when lying down ; sharp thrusts directly through 
the chest from sternum to spine, while sitting. 

Cough. — Short, hacking cough from itching and titillation 
in the throat. Cough excited by deep inspirations; violent 
cough with pain in the chest ; cough with pain in both sides of 
the abdomen ; nightly cough ; cough with yellow expectoration, 
tasting like bad eggs ; purulent expectoration ; cough from a dry 
spot in larynx. 

Aggravations. — At night, and when lying down. 

Accompaniments. — Pimples upon the chest; sore to the 
touch; pain in the mammae; hardness of right mamma ; glandu- 
lar swellings ; inclination to perspire during sleep, even of the 
cold limbs ; difficulty of breathing, both when at rest and in 
motion ; vertigo when turning over in recumbent position ; com- 
plexion pale and sickly; falling out of the hair; diarrhoea 
with tremulous weakness after every stool ; patient easily excited 
and greatly concerned about little things ; nervousness passes off 
in the open air. 

Conium patients are apt to be drowsy in the evening, but sleep- 
less after midnight, and annoyed with frightful dreams. A 
very common symptom is palpitation of the heart after 
drinking. 

The action of Conium seems to be primarily upon the spinal 
cord, corpora striata, and the ganglionic nervous system. It 
is among our best remedies for managing abnormal action in 
the greater and lesser glands so definitely related to the scrofu- 
lous diathesis, which is also the parent of tubercle. 

It expresses exhaustion of nervous energy ; voluntary mus- 
cles are weak and paralyzed ; mammary glands waste away. 

Conium has obtained high rank as a discutient, and possi- 
bly its fluidifying power whereby curdy and cheesy matters 
are made more ready for the absorbent vessels, explains much 
of the modus operandi of its curative action in our consump- 



180 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

tive cases. It has been used in both the high and low poten- 
cies. ' 

We have had no experience with Conium in the ulcerative 
stage of phthisis for ourselves ; perhaps have not tried it when 
it would have served ; yet it has a fine clinical record dating 
back to the earliest masters in our school. 

It will be found most serviceable to the female constitution, 
and in such cases as have uterine and mammary complica- 
tions or enlargements, and irritation of the larger glands. 

Clinical. — Case 1. Miss S. G., aet. 50; rather tall; very slen- 
der; muscles so attenuated as to amount almost to atrophy; ner- 
vous ; at times troubled with insane hallucinations ; aversion 
to men ; suspicious of some magnetic influence having been 
gained over her. Had a brother who committed suicide ; a 
sister who died of pulmonary phthisis beginning with he- 
moptysis. The mammary glands are shrunken, with active 
sexual desire ; glands sensitive, with occasional stitching 
pains. Had a hard fibrous tumor removed from the left gland 
by the sloughing process, some years ago, size of half a but- 
ternut, split longitudinally ; later hard nodule showed itself 
in right mammary gland ; is subject to a dry, hacking cough, 
coming on only when lying down. Conium 200 has prevented 
further advance of the tumor, and kept under control the 
trouble about the lungs, but has not cured the psychological 
symptoms. — G. N. B. 

DIGITALIS PURPUREA. 

Lungs and Thorax. — Great weakness of the chest, cannot 
bear to talk. Feels better lying quiet in a horizontal position. 

Cough. — Deep, hollow, spasmodic, excited by a sense of 
roughness or scraping in the roof of the mouth or trachea. No ex- 
pectoration in the morning, but small quantities of yellow, 
jelly-like mucus thrown off with difficulty in the evening. Some- 
times expectoration with a little dark blood. 

Aggravations. — About midnight or toward morning; from 
getting heated; also from drinking cold things (Ars.), and by 
talking and walking in the open air. 

Accompaniments. — Chill more internally, beginning with cold 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 181 

extremities, then spreading over the body, but with face warm. In- 
ternal chill with external heat. One hand hot the other cold; 
sweat on upper part of the body. Violent but not very rapid 
beating of the heart. Pulse slow when at rest. Hoarseness 
early in the morning, painful dyspnoea, worse when walking. 
Great fear about the future, which becomes worse about 6 P.M. 

Experiments with digitalis upon animals show that this 
agent acts powerfully upon the lung tissue, and the autopsical 
features have a close analogy to the immediate antecedents of 
tubercular deposition. The lung tissue is denser, especially 
that of the right lung, as if hepatized, and is of a violet color. 
The blood-discs are somewhat altered, and the blood loses its 
power of coagulating when death follows from the effects of 
digitalis. 

This seems to indicate a power of defibrinizing the blood, 
and if, as we have argued, phthisis is essentially a hyperfibri- 
nosis, it would seem that it might be utilized in the disease. 

The heart usually sympathizes strongly with all organic dis- 
turbances where Digitalis is indicated. 

Noack and Trinks speak of its action being especially on 
the sympathetic nerve and the cardiac plexus ; also of its ap- 
plicability to persons of a sanguine temperament, with light 
hair and soft muscles, and to the scrofulous diathesis. 

Dr. Beddars testifies that as a general rule when he has all 
possible evidences of the existence of tubercles in the lungs, he 
gives small doses of Digitalis, and that it has proved eminently 
successful. 

Frequently among the earlier evidences of tubercular affec- 
tion of the lungs are blood-discs in the sputum, or hemopt}^sis. 

The peculiar action of Digitalis on the heart, point to it as 
prominently a remedy in all cases showing this hyperaemic 
tendency of the pulmonary blood-vessels. We regard the hem- 
orrhagic diathesis when tending to localize upon the lungs, 
as especially suggesting Digitalis. It is in the period just 
preceding deposition and that intervening between depos- 
ition and softening, that it will probably be found most ser- 
viceable, although it may help much to allay the excessive 
cardiac action which is often so troublesome in the later stages. 



182 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

In many respects Digitalis is the analogue and support of 
Phosphorus, which also has the blood-stain in the sputum, the 
morning aggravation of the cough, and the aggravation from 
exercise in the open air and from talking. 

It is also prominently a remedy in hepatization of the lungs, 
a condition it is competent to produce proximately, at least, 
the pathological condition showing the lung to be dense with 
crepitating tissue. Phosphorus destroys the fibrin also, so that 
no trace of it can be seen even with the microscope; both 
these agents will serve us best in the commencement of our 
affections, particularly when associated with the hemorrhagic 
diathesis. As a check upon excess of fibrin in the blood, and 
as a hemastatic, we are not likely to overestimate its value. 
The more pronounced the cardiac symptoms the more is it 
likely to serve our patients. 

DULCAMARA. 

Lungs and Thorax. — Pains in left lung moving in waves ; 
hemoptysis of bright red blood, caused by a cold or a pro- 
tracted cough, attended by a tickling sensation in the larynx ; 
stitches here and there in the chest; lancinating pain in the 
middle of the sternum back to the spine when sitting, which goes ■ 
off on rising; pain in right side of chest, which goes to the back on 
pressure. 

All chest symptoms worse by change from hot to cold. 

Cough. — Hoarse, dry, rough and barking cough; panting cough, 
worse at each deep inspiration; loose cough, with copious ex- 
pectoration. Sputa; mucus in abundance; blood and mucus; 
greenish or greenish-yellow mucus. 

Aggravations. — By lying down and from warmth of room. 

Ameliorations. — By being in the open air. 

Accompaniments. — Chill, commencing in the back, not re- 
lieved by warmth; diarrhoea; emaciation; offensive night- 
sweats. 

EUPATORIUM PERFOLIATUM. 

Lungs and Thorax. — Soreness in chest worse from inspira- 
tion; pain and soreness behind the sternum; heart feels as if 
in too small a place. 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 183 

Pain through right nipple when breathing. 

Deep-seated pain in left side and right shoulder. 

Cough. — Precedes chill, sometimes night before. 

Rough scraping cough ; must support the chest with the hands 
(Bryonia) ; loose cough during apyrexia. 

Cough is apt to provoke retching, as in Drosera. 

Accompaniments. — Chills, usually occurring about 7 a.m., 
or from 7 to 9 a.m., a bad cough often attending both chill and 
fever stages; nausea during chill; vomiting of bile at end of 
chill. 

Eupatorium is fairly entitled to a place among our reme- 
dies for phthisis pulmonalis based upon a malarial cachexia. 
Thirst before chill, and nausea when fever sets in are character- 
istic symptoms. 

FERRUM METALLICUM. 

Lungs and Thorax. — Flying pains in the chest with palpita- 
tions; inter-scapular pains; left lung often feels as if oppressed 
above or at the nipple, where there is soreness, making breathing 
difficult. 

Pains in apex of lungs embarrassing breathing. 

Cough. — Spasmodic, from tickling in trachea; at night 
must sit up to raise sputa. Sputa ; copious, purulent, greenish or 
frothy; worse morning; or scanty and frothy with streaks of 
blood. 

Slight cough with hemoptysis of bright red color, occurring more 
frequently in morning, though may occur at night, cough worse 
from drinking wine or brandy, from use of quinine and from 
tobacco smoke. 

Accompaniments. — The face flushes easily, and veins feel 
hot; palpitations and dyspnoea. Patient feels better sitting up, 
though compelled to lie down from a feeling of weakness. It has 
been found a valuable remedy for hemoptysis following loss 
of fluids and onanism, also from suppression of the menses. 
With the heart symptoms we have the bellow's murmur and 
throbbing of the vessels. 

Ferrum fever is more marked in the afternoon and evening; 
the chill is attended with a hot and red face, with thirst as in 
hectic fever; sweat profuse and long-lasting. 



184 PHTHISIS PULMONALIS : TUBEKCULAE, PHTHISIS. 

We are persuaded that iron has been used in tubercular 
cases in altogether too crude a form. We also believe an im- 
prudent use of iron in cases of ovaritis and menstrual arrest, 
has resulted in provoking rapid tubercularization of the lungs. 
This mistake often occurs in treating girls from the age of 
fourteen to twenty ; and yet it would seem from the peculiar 
action of Ferrum, that if properly used, many of these cases of 
anaemia and possibly the more acute affections of the ovaries 
might be successfully treated. 

We have personally observed the rapid production of tuber- 
cle in the lungs from Ferrum muriaticum when given in over- 
doses to tubercular patients. If it will produce tubercle it 
should arrest tubercle when properly prepared and prescribed. 

The person on whom our observations were made was of a 
nervous sanguine temperament, rather tall and spare. She 
had taken iron some ten days only, when the tubercular dul- 
ness had spread over double the space previously occupied, 
and the heart's action became so excited that there were strong 
jerky contractions occurring frequently at the time of our ex- 
amination. Ferrum then would seem to be preeminently 
adapted to the period of active exudation and with a high 
grade of arterial excitement; also to a condition of active con- 
gestion with tendency to hemoptysis. The peculiar action of 
Ferrum upon the blood-corpuscles also affords the inference 
that those molecular changes connected with the transforma- 
tion of tissue can be modified with Ferrum in a way to benefit 
our tubercular cases. 

Favorable as may be the view we have taken on this subject, 
it is undeniably true that more harm than good, thus far, has 
come from the use of this remedy. It remains to be seen if 
with the advanced dilutions our record shall be improved. 
We confidently predict that with the use of the thirtieth po- 
tency and upward, chosen carefully in accordance with the 
law of similars, disappointment of reasonable expectation in 
this very potent remedy, will not follow. 

In one chlorotic case we witnessed a remarkable action of 
Ferrum muriaticum when taken in a little wine. Patient 
gained color, expectoration decreased, hectic fever subsided, 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 185 

and strength improved. She died from an attack of pneumo- 
nia before cure was completed. 

FERRUM IODATUM. 

In some cases of extreme emaciation and debility following 
drains upon the vital forces, we have succeeded wonderfully 
with the iodide of iron. One case of impotence, in a scrofulous 
person, whose two brothers and a sister died of consumption, 
and who himself had reached the stage of advanced marasmus, 
was cured in my early practice with this remedy prepared 
freshly by adding a little water to iodine and iron filings, and 
preserving the preparation by the addition of sugar. 

The blood changed color, flesh returned, and the impotence 
which was so bad that semen was lost daily without erections 
was cured in a few months. I have little doubt but for the 
Ferrum iodatum my patient would have died with phthisis 
pulmonalis in a year or two at longest. In this case and the 
case improved by muriate of iron, the complexion was not of 
the florid kind with that of Mrs. Hall where tubercles were so 
rapidly multiplied under the action of Ferrum muriaticum, 
nor was there any considerable acceleration of the pulse in 
either case ; complexion of one was a dingy yellow or sallow 
and the other more of an earthy hue. Our literature does not 
furnish, so far as I know, clinical experience to the extent of 
giving Ferrum and its compounds their proper value in the 
treatment of phthisis pulmonalis. 

Clinical. — Case 1. — " A woman, set. 48, mother of several 
children, of sanguine temperament, slender, tall, had three at- 
tacks of pneumonia during her childhood and had been treated 
by bleeding, followed by frequent nose-bleed, spitting of blood, 
diarrhoea, catarrhal affections. In her thirty-second year dis- 
appearance of menses ; flat, narrow, lengthened thorax; depres- 
sion in the subclavicular region; loss of strength, emaciation, 
chilliness and shiverings in the evenings with subsequent 
fever and night sweats, cough at first dry, later accompanied 
with green, purulent expectoration containing little lumps of 
a cheesy substance ; oppression of the chest, likes to lie on her 
back ; tympanitic sound on the sides of the thorax ; bronchial 
13 



186 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

breathing, and near the clavicles vesicular crepitation. Gave 
Ferrum iodatum (20-30), three to four grains each day, lessen- 
ing of copious expectoration, no more oppression of the chest, 
cough less frequent, expectoration only of tracheal mucus, 
disappearance of the fever symptoms, improved appetite, im- 
proved regularity of the bowels, stools greenish-black; she 
gains strength rapidly and has become cheerful and hopeful ; 
this improvement has taken place in six weeks." — Altschul, 
Pr. Mon. Schriften, 1, 68. 

HEPAR SULPHURIS CALC. 

Lungs and Thorax. — Sensation as of drops of hot water in 
left chest. Spasmodic constriction of the chest after talking. 
Stitching pain in side of chest towards the back. 

Cough. — Cough with constant hoarseness; sensation as if 
there were a fishbone in the throat. Cough brings on vomiting; 
coughs when eating (Lach.). Cough barking, wheezing, chok- 
ing. Expectoration bloody, frothy, with tuberculous products. 

Aggravations. — Worse before midnight and in the morning. 
By cold air coming in contact with any part of the body; hence 
great dread of undressing. By recumbent position. 

Accompaniments. — Chills from the least exposure of the body ■ 
to the air. Paleness upon the least exertion, followed by burning 
redness of the face, and heat in .the palms of the hands; at this time 
perspires easily. Stomach is apt to be out of order; longing 
for sour things. 

Dunham gives the symptom of " feeling as of a hard body in 
the epigastrium, immediately followed by a hemoptysis." 

Guernsey : " Person smells sour." 

From the known value of Hepar in suppurative actions, as 
well as its power to correct glandular derangements, it sug- 
gests itself in the suppurative or ulcerative stage of tubercular 
disintegration. The low vitality and extreme sensibility to cold 
of many of our consumptives, those who come to us bundled 
heavily to keep out the cold even in pleasant weather, will 
often be met by Hepar better than by any other remedy. Cer- 
tainly as an adjunct to some other of our most important 
remedies it is indispensable. 



phthisis pulmonale: tubercular phthisis. 187 

Dr. H. C. Allen reports a case of protracted catarrh cured by 
Hepar, where the cough was worse night and morning, and vio- 
lently aggravated by recumbent posture. Associated with this 
was the dread of undressing, because of the terrible paroxysms of 
coughing provoked by change of temperature, impressing the skin. 
Cough was aggravated by exposing any part of the body to 
the cold. 

IODIUM. 

Lungs and Thorax. — Sensation of weakness in the chest. 
Stitches and burning in the chest after a dry cough. Sharp, quick, 
piercing pains. 

Cough. — Dry morning cough from tickling in the larynx. 
Cough provoked by constant tickling in the trachea, and under 
the sternum. Cough with expectoration of large quantities of 
transparent mucus, often streaked with blood. 

Accompaniments. — Unaccountable weakness and loss of 
breath on going up-stairs; laryngeal cough with diarrhoea, slow 
fever, night sweats, and emaciation. 

This remedy seems especially adapted to that class of pa- 
tients who emaciate while eating well; indeed, they often have 
ravenous appetites. 

Another class of cases to which Iodium will be found ser- 
viceable has goitre in the family, or possibly in themselves, or 
traces of partially cured goitre. Other conditions indicating 
its adaptability are : scrofulous persons with low cachectic 
state of the system ; women with dwindling of the mammae (Con.), 
or shrinkage of the adipose tissue, mammse are sore, with uter- 
ine disturbances (Conium); women with amenorrhcea, with 
lung complications. 

Hughes says: "It seems capable of doing everything but 
checking the deposition of fresh tubercle." 

Perhaps we could do more with higher attenuations. 

Lippe gives "emaciation with good appetite." 

If it should be determined that the value of cod-liver oil 
was owing to the presence of Iodine in solution in infinitesi- 
mal doses, such cases as are reported cured by oil, would 
largely go to the credit of Iodine. It is worth while to collect 



188 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

data from the cases to which oil proves curative; if of the 
Iodine type, the probabilities will be very greatly in favor of 
Iodine being the curative element. 

Some have reported benefit from the inhalation of Iodium 
in tubercular affections of the lungs; it has such a value for 
scrofula, it would seem as though we should find a class of 
cases where it will prove a leading remedy. In the early stage 
of the disease, when emaciation first declares itself, especially 
if there be a good appetite, and flesh continues to shrink all 
the same, we should expect Iodium to act beneficially. 

Itching in lungs low down, and extending up through the trachea 
to the nose, and itching of the tip of nose before coughing, are char- 
acteristic symptoms. Hering thinks it agrees best with per- 
sons with dark hair and eyes. Mentions it for overgrown boys 
with weak chests. Dr. Muller gives an interesting Iodium 
case. 

Clinical. — Case 1.— "A lady, ast. 27, was attacked by influ- 
enza which was followed by hoarseness, cough, dyspnoea, de- 
bility, and emaciation, which steadily progressed. Cough was 
quite suffocative. Took Phosphorus and Hyoscyamus, but 
with no improvement. A later and more complete catalogue 
of symptoms gives us: excessive lassitude and weakness, is. 
hardly able to walk twenty steps; considerable emaciation; 
dyspnoea from the least exertion; irritability with hot flushes 
and palpitation ; dry heat every afternoon, with thirst and dull 
feeling in the head; restlessness and insomnia at night; per- 
spiration toward morning; little appetite, gastralgia and con- 
stipation. Voice hoarse and weak, without timbre. Constant 
pressure in the throat, with burning, including larynx, trachea 
and bronchi; a sensation of rawness which provokes an incli- 
nation to hem and cough ; sensation of weight and pressure in 
the chest; a short dry cough day and night, with an exacerba- 
tion two or three times daily of severe spasmodic turns, with 
breathlessness, heat in the face and head, and exhaustion. 
Sputa tough, scanty and thick, with occasional streaks of 
blood. Menses scanty, almost absent. Skin dry, pale, of dirty 
gray color. The superior clavicular region depressed, espe- 
cially on the right side; feeble and irregular motion of the 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 189 

thorax when breathing; sound of percussion empty on both 
apices; on the apex of right lung bronchial respiration, lower 
down indistinct and slightly vesicular breathing; beat of heart 
strong; second pulmonary sound increased on the neck; ven- 
ous murmurs. 

" Diagnosis, pulmonary phthisis. Case was now put upon 
Iodium 3 with very decided benefit. Dose, one drop morning 
and evening. Mercurius sol. 3 was given after four weeks, for 
some symptoms that did not seem to yield, for the evening 
dose, but we should say with doubtful utility. 

" Voice improved, cough decreased, and improvement went 
on so effectively that the lady was in a condition to become 
pregnant after four months. Was finally delivered of a child 
at full term. 

" Though not fully cured perhaps, as the clavicular region is 
still depressed, and she becomes easily fatigued, yet she has no 
cough, and her voice is clear and flesh fairly good." 

KALI BICHEOMICUM. 

Lungs and Thorax. — Pains from back to sternum or shooting 
pains from middle of sternum back between shoulder-blades. Sharp 
pain through apex of left lung to shoulder-blade (Sul.). 

Cough.— Wheezing cough, with expectoration of tough stringy 
mucus, pulling out into threads. 

Aggravations. — Worse while undressing (Hepar s. c), and 
after eating, 

Accompaniments. — Emaciation, night-sweats and quick 
pulse. 

This remedy has great power as a solvent, and acts as a 
check to plastic exudations in throat and within the respira- 
tory tract, and no doubt is adapted to the management of a 
certain class of cases of a tubercular character, especially to 
fleshy people who become tuberculous, or have caseous affection 
of the glands. It is adapted to light-haired persons who have a 
tendency to baldness or loss of hair; also to persons subject to 
chronic catarrhs. 

Clinical. — Case 1. — "Mrs. C, set. about 28, had taken cold in 
the early autumn. From repeated exposures came a cough 



190 PHTHISIS PULMONALISI TUBERCULAR PHTHISIS. 

which rapidly grew- worse, accompanied with extreme emacia- 
tion; has been a plump woman. Symptoms are : broken feeling 
in back after walking, eased by sitting bent forward: dragging 
down feeling in the back and hypogastrium; violent cough, 
worse in the night, better by lying on the left side, worse on the 
right side and still worse when lying on the back. Sharp pain 
through the apex of the left lung to the left shoulder blade 
(Sul.) and through the base of the right lung to the right shoulder 
blade; expectoration thick, yellowish, stringy and offensive; 
coughs always after the least mouthful of food or drink and worse 
from a change to cold air; great thirst; profuse night-sweat 
and also day-sweats which are worse about the head; pulse 
weak, 120 beats per minute and quick. This was not a case 
of pneumonia; the history, the character of sputa and physical 
signs were against it, and it was something more than acute 
bronchitis. I found on examination distinct evidences of a 
small cavity in the upper part of the left lung, and some tu- 
bercular deposit in the lower part of the right lung. Gave 
her Kali bichromicum, third decimal; patient made rapid 
progress and to a fair degree of health, though not as strong 
as formerly. One dose of Phosphorus 500 (Tafel) w r as adminis- 
tered before patient was discharged." — H. N. Martin. 

Case 2. — Mrs. M. P., set. 38, rather fleshy and of light com- 
plexion, has been coughing for several weeks and from family 
history fears consumption; she has sharp pains accompanying 
her cough which begin between the shoulder blades and pass 
through into the chest: raises a stringy, tough sputum when she 
expectorates anything, cough being inclined to dryness ; coughs 
worse on going to bed and after eating. Cured by Kali bichro- 
micum 30 .— G. N. B. 

KALI CARBONICUM. 

Lungs and Thorax.— Stitching pains, suddenly coming and 
going; more apt to be in the right side. "Stitching pains in the 
right side commencing in the back and going through the chest, 
which are worse at night, when lying down or rising." — H. N. 
Martin. 

"Darting stitches in the lungs, and against the sacs of pus 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 191 

in the lungs; pains coming on, on lying down." — Noack and 
Trinks. 

Cough. — Dry, hard, exhausting. Sometimes hard cough 
with purulent expectoration mixed with blood and thin mucus; or 
hard, round, white masses fly from the mouth when hawking or 
coughing. 

Aggravations. — By eating warm food, by exercise, by lying 
on the left side (Phos., Lye). 

Worse about 3 A.M. Trinks says all the symptoms get regu- 
larly worse about 3 o'clock in the morning. 

Ameliorations.— Cough better after breakfast. 

Accompaniments. — Serous sacking of the eyelids. 

Raue gives: "Stitching pains in temples, eyes, ears, teeth and 
different parts of the body. After dinner, nausea, faintishness and 
sleep ; about noon, chilliness ; at night, heat." Our own verifica- 
tions have been in affections of the lower portion of the right 
lung, where there was dulness on percussion; stitches with a 
cough mostly dry, but an occasional expectoration of bloody 
muco-purulent matter; with much difficulty in lying down. In 
cases of asthma and hydrothorax, we have regarded the symp- 
tom of relief upon leaning the elbows upon the knee, as character- 
istic. Kali carbonicum is adapted to ansemic and dropsical con- 
stitutions. The cases of consumption most likely to be benefited 
by this remedy, are such as have a catarrhal or pneumonic 
basis, or when asthmatic, cardiac and dropsical symptoms 
complicate the lung symptoms. It is considered better adapted 
to that stage of tubercle when the breaking down process has 
set in ; when the cough is still exhausting and dry, and hectic 
and emaciation are present. It follows Lycopodium to good 
advantage and is itself often a leader to Carbo vegetabilis, and 
sometimes to Phosphorus. 

It is a remedy to be thought of in complications from em- 
physema and pleurisy. 

Clinical. — Case 1. — "B. D., a girl set. 6, had an attack of 
measles which was followed by a severe cough of a dry char- 
acter. Stitches and pressing in the chest; breathing short and 
oppressed ; the cough was a short teasing one with two or three 
paroxysms in rapid succession, usually dry, but with a feeling 



192 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

as if some tough mucus was moved about in the trachea which 
could not be raised. Eating and drinking increased the cough. 
Dulness on percussion in the lower part of the chest, where is 
also pain. Kali carbonica 200 cured." — Schelling. 

Jahr says: "That under the action of Kali carb. dyspnoea 
with violent and irregular beats of the heart disappear, but the 
latent tubercles remain the same." 

0. W. Smith reports the following : " Expectoration of firm 
white globular masses of the size of a pea, flying from the mouth 
with considerable force when coughing or hawking; eruption of 
minute vesicles on the feet with extensive itching. Burning in 
top of head and soles of feet (Sul.). Sweaty paleness; circum- 
scribed red spot on one cheek; gastric derangement with belching 
tasting like rotten eggs; hungry and faint about 10 a.m. (Sul. 11 
a.m.); contraction of the heel cords; trembling sensation through 
the entire body, especially through the pelvic region. The 3d 
trituration cured where the 200th had failed." (Comparisons 
with Sulphur are our own.) 

KALI HYDROIODICUM. 

Lungs and Thorax. — Stitches through the sternum to the 
back, or deep in the chest while walking. 

Cough. — Suffocative cough; cough dry, hawking; later with 
copious green sputa, or like soap-suds. 

Accompaniments. — Kali hydrojodicum has many symp- 
toms similar to Iodium. It has been used successfully in 
pneumonia with extensive hepatization, for purulent expectora- 
tion, with exhausting night-sweats and loose stool. As in Iodium, 
we should regard excessive and rapid emaciation a most import- 
ant symptom in the selection of Kali hydrojodicum 

Clinical. — Case 1. — " A woman, set.' 30, subject to catarrhal 
affections, has had for a period of six months a stubborn cough ; 
pain in the chest ; weakness, remarkable emaciation ; fever, with 
exacerbation and profuse night-sweat. Physical examination 
gives unmistakable evidence of the existence of several cavities 
in the upper lung ; breathing is difficult ; the tongue red ; the 
hair is falling out. Menstruation has disappeared, and in its 
place a stubborn leucorrhcea shows itself. The use of Kali 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 193 

hydrojodicum internally, and the inhalation of steam medi- 
cated by Iodium, soon brought about a remarkable improve- 
ment. 

The first favorable change showed itself in a freer respira- 
tion, and in the cessation of night-sweats, followed by a lessen- 
ing of the cough, return of strength, remarkably good appe- 
tite, and finally, disappearance of the fluor albus, with which 
the patient had been afflicted on a former occasion, and per- 
fect recovery. After several years she is now in the best of 
health." — Lobethal, in Allg. Horn. Zeitg., XX, 53. 

KALI MURIATICTJM. 

We have no personal experience with this remedy, but find 
a valuable clinical report which we give : 

Clinical. — Case 1. — " A lady, set. 35, and married, consulted 
me for catarrhal phthisis affecting a small space in the upper 
right lung, with a crackling respiration, audible even to patient 
when recumbent. Expectoration greenish ; dulness on percus- 
sion ; paleness ; emaciation ; fever inconsiderable ; cough was 
of some month's standing ; patient had taken cod-liver oil ad 
nauseam. Prescribed Kali mur. 30 , three times a day, and gave 
her freely a preparation made of one-fourth pound of finely cut 
suet, simmered in two pints of milk down to one pint, as a 
substitute for the oil preparation, simmered in hot water to pre- 
vent burning; fat rising on cooling to be skimmed off. Patient 
steadily improved for months, when an aggravation of cough 
took place which I attributed to my remedy. Gave' remedy 
only every third day subsequently. The green color of sputa 
soon diminished under treatment, and the crackling sounds 
in the bronchi. Ten months from commencement of treat- 
ment patient's weight was nearly normal and she was steadily 
gaining. Slight dulness, however, remained. Patient appar- 
ently cured excepting this. She went to her friends in another 
State. She relished her suet and milk well." — J. C. Morgan. 

LACHESIS. 

Lungs and Thorax. — Stitches in the left side of chest, with 



194 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

dyspnoea and constriction of the chest. Oppressive pain in the 
chest as if full of wind. 

Cough. — Gagging persistent cough from tickling in the throat" 
Violent and long-continued cough from slight pressure on the larynx. 
A dry, hacking cough from simply touching the throat. Occa- 
sionally a spasmodic cough worse in the evening and at night, with 
tickling in the throat. The expectoration is scanty and contin- 
ues blood-streaked, usually scanty and difficult to raise. Patient 
sometimes coughs in sleep without waking. 

Aggravation. — During the day; on failing asleep; from change 
of temperature ; after sleep. 

Accompaniments. — Larynx and throat painful when touched 
and on bending the head backwards; when anything touches the 
larynx the latter is not only very sensitive, but there is a sense of 
suffocation felt; patient cannot bear clothing to touch the neck. 

A majority of the symptoms are felt upon the left side ; this 
and the aggravation after sleep are very important. The influ- 
ence of this remedy seems to be very pronounced upon the 
blood, the pneumogastric nerve and the ganglionic nervous system, 
and through them upon the respiratory function producing 
hypersesthesia of the tissues about the chest. We have again 
and again proved its power to arrest plastic exudations in the 
throat when upon the left side; hence we judge it will best 
serve us in affections of the left lung. 

In acute albuminous affections of the kidneys we have also 
found it a very valuable remedy. It is best adapted to the 
early stages of tubercular pulmonary diseases, so far as our 
own experience goes. It seems especially adapted to the female 
constitution. 

Additional accompanying symptoms not mentioned above : 
Fever worse in the afternoon; stools smell offensive though nor- 
mal in appearance; throbbing in the anus; itching after sleep. 

Clinical. — Case 1. — Miss McM., set. 19, of slight build, pale 
complexion, thin brown hair and decidedly of the nervous 
temperament, had been in declining health for three years; 
was now too feeble to ride out except for very short distances; 
pale face, or ashy color, with blue veins, soft tissue with a gener- 
ally frail and delicate look. Found her troubled with a severe 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 195 

cough of rather a dry spasmodic character; worse in the morning 
and after lying down, especially after having slept; cough was 
also worse whenever there was a change of weather; from her 
low state of vitality she was very susceptible to the depressing 
influences of cold and dampness; cough often seemed to be 
produced by a tickling sensation in the larynx, though the left 
lung was the principal seat of the difficulty, where there was 
soreness, pain and dulness in upper portion ; menstruation was 
quite scanty, pale and delayed about two weeks; some tender- 
ness in the hypogastric region. Patient had been steadily 
growing weaker for two years and getting worse of her chest 
troubles till now her case was pronounced incurable and she 
was put upon cod-liver oil, on which we found her. She got 
Lachesis 200 , and was kept upon it till cured and no relapse had 
occurred ten years later. — G. N. B. 

Case 2. — "Miss Emma B., set. 26, was the constant nurse of 
her younger sister, who died January 26th, 1871, of tubercular 
phthisis; she was not only in the same room day and night 
with the patient, but during her illness for about six months 
she slept in the same bed with her; slept with her up to the 
last night of her sickness. My attention was called to Miss 
Emma June 9th, 1879; she had been coughing for more than 
two months; the cough was frequent, dry, short and sharp or 
harsh in sound; she is tall, of slender form, prominent clavicles 
and now considerably emaciated; she has light brown hair 
and blue eyes; there was loss of appetite and strength; great 
flow of spirits and a constant affirmation that she felt no pain, 
was not at all sick ; pulse 96, small. On the 24th, an exam- 
ination three times repeated because of her assurances that 
there was nothing the matter, established the fact beyond all 
doubt that no air entered the posterior superior half of the left lung, 
i. e., no respiratory murmurs could be heard in this part of the 
chest, though well enough heard in the corresponding portion 
of the right lung ; taking into account the family tubercular 
taint, the constant contact for six months with the sister dying 
of tuberculosis, the emaciation, loss of strength, frequent pulse, 
the character of the cough, its persistent continuance, the pe- 
culiar disposition of mind, I could not but conclude that there 



196 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

was tubercular infiltration of the part affected ; though there 
could be no certainty of the truth of this conclusion, the prob- 
ability to say the least of its correctness is very great. Re- 
garding Lachesis as having more points of resemblance to our 
case than any other remedy, I dissolved six pellets of the 200th 
of this remedy in a half tumbler of water and directed patient 
to take a teaspoonful night and morning for six days ; eleven 
days after the state of the lung was carefully examined and 
the respiratory sound was heard in that part of the lung where 
at first examination it was absent; a subsequent re-examina- 
tion showed that the lung was clear of obstruction." — P. P. 
Wells. 

The two cases show a left-sided affection and a violent, some- 
what spasmodic, cough, dry in character. The impression of 
Lachesis is very profound upon the nervous system, is pro- 
ductive of plastic exudations and most of the symptoms are 
left-sided. The cachexia is a blood cachexia with glandular- 
excitement and adventitious loading down with nitro-carbons. 

Case 3. — A young man of phthisicky habit who had pneu- 
monia treated by bleeding, has been failing for six months, 
is greatly emaciated and has a constant cough. Symptoms: 
short, superficial hacking cough, very exhausting, sometimes result- 
ing in vomiting; expectoration is very difficult, scanty, either thin 
tough mucus or thick, round, small lumps which fly in different 
directions (Kali carb.) ; quite often he coughs, hacks and spits all 
at once without being able to raise anything; he coughs only during 
the day (characteristic of Lachesis, as is cough during sleep,- 
but he is not conscious of the latter). The cough is aggravated 
from walking in the open air, also from talking, which seems to 
cause a sensation of dryness and consequent inclination to cough ; 
worse also after damp weather and eating fish; it often seems as 
if the cough started in the pit of the stomach, where it tickles 
and is so painful during a hard coughing spell that he is 
obliged to press against something (Phos.); during the cough 
there is an ulcerative pain under the ribs and in the trachea, 
also accumulation of water in the mouth; shortness of breath, 
especially after exercising with the arms ; stiffness and weakness 
in the knees when rising ; weakness obliges him to stoop when 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 107 

walking. In the forenoon nausea, loss of appetite. Gave 
Sepia; the first dose was followed by improvement which con- 
tinued for three weeks, after the second dose he grew worse; 
the characteristic symptoms, especially aggravation of the 
cough after sleep pointed to Lachesis; one hour after taking 
Lachesis the cough became worse, he expectorated some yellow 
matter, after that the cough became looser, easier, less frequent; 
after several doses the symptoms had almost wholly disap- 
peared and eventually he felt well and strong.'' — Hering in 
Archiv., XV, 1, 56. 

LYCOPODIUM. 

Lungs and Thorax. — Continuous pressure on the chest, raw 
feeling internally. Paralysis of the lungs. Neglected pneumo- 
nia, with continuing hepatization. 

Cough. — Dry, day and night, fatiguing ; affects stomach and 
head. Sputa gray or grayish-yellow, more rarely yellow, and 
tastes saltish. 

Aggravations. — From 4 to 8 P.M.; on alternate days; from 
stretching the arms out; from stooping and lying down; in wind, 
or in a warm room. 

Accompaniments. — Chill from 4 to 8 P.M., with numb hands 
and feet, icy cold at 7 P.M. Sour vomiting between chill snd heat; 
flushes of heat over the whole body, toward evening; with frequent 
drinking of small quantities at a time (Ars.) ; with increased mic- 
turition. Sweats from least exertion (Merc). Heat, with inclina- 
tion to uncover. 

Lycopodium has a powerful influence upon plastic exuda- 
tions on the right side (reverse of Lachesis). It acts in a most 
efficient manner to remove excreta through the kidneys, and in 
a somewhat pronounced manner also through the alimentary 
tract and skin. As a solvent to albuminoids our observations 
have been extensive in regard to diphtheroid affections com- 
mencing upon the right side; many symptoms travel from right 
to left. It seems pretty well settled that in pneumonia passing 
into hepatization, and for the suppurative stage of hepatization, Ly- 
copodium is a decided remedy; and further, evidence tends to 
show that in tubercular affections allied with pneumonia, and in 



198 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

cases of hemoptysis followed by purulent expectoration, whether 
from tubercle or otherwise, Lvcopodium may be expected to 
ameliorate the symptoms, and postpone fatality indefinitely. 
To what extent it shall prove sufficient to eradicate the tuber- 
cular diathesis, and remove the tubercle from the lung, may 
be regarded for the present as an open question ; but it cer- 
tainly is a remedy to be most carefully studied, as many of our 
fatal cases of pulmonary disease come from old catarrhs and 
badly managed pneumonias. 

In chronic catarrhal affections Lycopodium has for a long 
time held almost the foremost place. Hitchman reports a case 
of pneumonia supervening upon tubercular deposit, accompa- 
nied with pleurisy and serous effusions, cured by Lycopodium. 
" There was diminished resonance and mobility of chest with 
flattening; tubular breathing and cavernous sounds; pulse inter- 
mittent and small; voice weak; cough severe day and night, 
with profuse expectoration ; hectic fever and night sweats ac- 
companied ; and the hand on the suffering side cold and emaciated 
was used to indicate his wants." 

Dr. Pope says : " Few medicines are so valuable in pulmon- 
ary phthisis as this when persistently used; the cough, gastric 
irritation, exhaustion and intercurrent attacks of pleurisy, are 
wonderfully mitigated by it." . 

Raue verified it in "a case with expectoration of large quan- 
tities of pus; cough day and night; hectic fever; circum- 
scribed redness of the cheeks." 

Burt recommends it for subacute and gradually advancing 
chronic cases, and for people with sallow complexion and cold 
extremities. 

Clinical. — Case 1. — " W. M., a boy, set. 14, very feeble and 
always remarkably thin, of very weak muscular development, 
but of sensitive mind and excellent intellect, whose mother 
had died of consumption, has the following symptoms; hard 
dry cough all day and night; coughs also in his sleep; then 
violent dry cough in the morning; great emaciation; is so fee- 
ble that he can hardly stand; no secretion of mucus from the 
lungs; respiration, and pulsation of heart very rapid; but aus- 
cultation and percussion elicit no signs of decided disease of 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 199 

lungs; appetite voracious. Administered Lycopodium 200 , two 
closes. Cough was rapidly cured, and boy soon well as usual." 
— C. Wesselhoeft. 

Case 2. — Miss Jennie Y., set. 15, with blue eyes, fair 
complexion and light hair, very forward in her studies and 
with quite a genius for music, very nervous and easily ex- 
cited, has suffered considerable from malarial influences; been 
troubled with a dry cough more or less for two or three years; 
was poorly all winter, and finally early in March was taken 
down with chills, to which was added an aggravating cough 
and hectic fever. Left lung very sore all over the region above 
the mammse, so sore that percussion is hardly tolerated; dull 
sounds show condensation, and the bronchial murmur is quite 
too distinct; fever was almost continuous, with a perceptible 
aggravation in the afternoon and evening; chill at 7 p.m. quite 
regularly with night sweats, which were sour; chill begins on 
left side of body ; thirst during chill and a little before; constipa- 
tion; no appetite; pulse 120; sometimes vomits a little, which 
is sour. Patient was treated by myself and by my colleague 
at times for three months with no improvement, but on the 
contrary, with a steady loss of strength and flesh ; nothing did 
her any good till Lycopodium 200 was given, when her chills 
yielded for the most part, and quite an abatement of the fever 
followed ; she still coughed badly and rallied but slowly until 
she was given Tuberculinum, C. M., Swan, after which she 
mended rapidly, beginning to eat pork, which she craved, and 
some vegetables; chicken and lamb were added to her diet 
also; cream in wine and malt in beer she used freely. As I 
shall speak of the case again under Tuberculinum, I refer the 
reader to that remedy for the further history of the case. — 
G. N. B. 

These cases with the one I have reported in chapter on 
hemoptysis, lead us up pretty clearly to the tubercular dys- 
crasia and tubercular deposit, and shows that there is good 
reason for believing that Lycopodium should be classed 
among our remedies capable of modifying the coarse of a 
phthisis, and indefinitely postponing the suppurative crisis and 
possibly of radically arresting the course of a caseous exuda- 
tion having its origin in a scrofulous cachexia. 



200 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

C. C. Smith writes me that he has found Lycopodium "espe- 
cially useful in dry coughs, day and night, in feeble emaciated 
boys. Chill every seventh day." 

Raue mentions that patient does not like to be covered. 

Case 3. — Mrs. C. H., set. 27, of a sanguine bilious tempera- 
ment, was taken with cough and blood-spitting about one year 
ago while keeping school, but did not leave her work. Coughed 
violently, raising but very little. Second attack of blood-spit- 
ting the following January. Lungs felt sore from coughing. 
Three months later began to expectorate and has continued to 
do so till the present time, and now raises very freely a green- 
ish muco-purulent matter with putrid taste. Cough is worse 
night and morning, though she usually wakes once or twice in 
the night and coughs. Night-sweats set in soon after second 
hemoptysis. Menstruated till the 1st of September ; has seen 
nothing since (five months). Chills and fever more marked 
at that time than before or since. Chill appeared in the after- 
noon, and fever lasted till late in the evening. Night-sweats of 
a sour musty odor staining the undergarments yellow. Sweating 
stage usually the last of the night. Has steadily lost flesh from 
the first; appetite poor, hardly able to eat at all. Feet and 
hands cold. Complains that her lung smarts and is sore, more 
particularly at the third rib upon the left side and midway 
between the sternum and shoulder-joint; has at times a pain 
which seems to go back to the shoulder-blade (Myrtus, Sul.). 
Percussion reveals dulness over a large part of the left apex, 
and auscultation gives us broncophony and heavy rales as if 
from a cavity. Voice also resounds from the chest. Feet bloat 
in the daytime; hands and feet sometimes numb. Has ob- 
served at times a reddish-brown sediment deposited from the 
urine. Cannot lie upon the left side. Gave Lycopodium 200 , one 
dose, and put her upon cream and milk a pint a day divided 
into three parts, to which she adds a teaspoonful of brandy on 
taking ; ordered malt with her food. 

Improvement of fever and night-sweats; a trifle better of 
cough four days later. Repeated the dose. Six days later 
slightly improving, but says she is sleepy all day, and when she 
coughs she puts her hand upon the pit of the stomach to relieve the 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 201 

pain and bad feeling. Always coughs if she turns upon the left 
side, Gave Phosphorus 200 , one dose. Patient steadily mended, 
though very slowly, for two or three weeks, meantime making 
a visit of a week to her home in the country. Returned, say- 
ing she was feeling better generally; was stronger, did not 
cough as much, but had soreness of the throat on the right 
side which was aggravated by her cough. 

Gave Lycopodium 10m (Fincke); continued to improve for 
one week when she caught cold, and had an inflammatory 
attack upon the right lung attended with an aggravation of 
cough, soreness and stitching pains through to shoulder-blade. 
Gave Bryonia 200 ; cough and pains soon better; continue Bry- 
onia and let her go to her friends in the country. Talked a 
good deal and from the excitement had another attack of 
hemoptysis. Sent her Aconite which she took twice a day 
and returned not appearing the worse for her hemorrhage. 
Cavity in lung less loaded with purulent secretions as evi- 
denced by the rales and amount expectorated. Dulness yet 
remaining over the upper third of left lung. Gave Sulphur 10 " 1 , 
one dose, being guided thereto by growing dryness of cough, 
soreness of chest in region of third rib, with a sore feeling 
seeming to go deep back toward the scapula. Ten days later 
patient complained of having taken cold and getting a sore- 
ness low down in the right chest- walls, or over the superior 
portions of the liver. Pain stitching in character. Gave Kali 
carbonica 200 , a single dose. 

Reports better two days later and goes to the country again. 
Subsequent two months patient took a dose of Lycopodium 
once a week and continued to mend slowly. This case is 
under treatment and final result cannot be reported, but there 
is fair prospect for recovery judging by present symptoms. — 
G. N. B. 

This case is not so valuable as a clinical verification, because 
of complications seeming to call for other remedies, still the 
author trusts it is not altogether wanting in suggestiveness. 
Putting the cases reported under hemoptysis and chronic pneu- 
monia with the above, I think Lycopodium is shown to hold a 
high rank among remedies which may be successfully relied 
. "14 



202 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

on to modify the'course of a consumption, and perhaps control 
the dyscrasia out of which it has developed. 

MERCURITJS VIVUS. 

Lungs and Thorax. — Stitches in the left chest during in- 
spiration and between inspirations. Stitch in the anterior supe- 
rior portion of the chest extending through to the back, when cough- 
ing. 

Cough. — Violent racking cough every other evening; cough 
w r ith pain in the chest and small of the back. Severe, dry cough, 
or cough with bloody sputum in tuberculosis. Short dry cough 
excited by tickling in upper anterior walls of the chest, very 
fatiguing and hardly allowing one to speak. Violent night cough. 

Aggravations. — Night air; dampness. 

Accompaniments. — Shortness of breath as if one had in- 
spired smoke ; shortness of breath on going up-stairs, and on 
walking, as if one could not take in sufficient air. Chill more 
generally in the evening after lying down, not relieved by 
warmth of the fire; internal chill with heat of the face; heat with 
sensation of pressing together of the chest, anxious; heat with 
aversion to uncover. 

Often there is an inclination to vomit during coughing. 
Sometimes we have hoarseness and aphonia. 

Mercurius has proved curative in suppuration of the lungs 
after hemoptysis, in tuberculosis with bloody sputum, also in 
abscesses following pneumonic hepatization. It is thought to 
act more decidedly upon the lower portion of the right lung 
(Hering). Headland affirms that Mercury has the power to 
deprive the blood of one-third of its fibrin, one-seventh of its al- 
bumen, one-third or more of its globules, and at the same time 
loads it with fatty matter. The tendency of the morbific force 
of phthisis to transform albumen into fatty matter presents an 
analogy of action, strengthening, as it would seem, the homoeo- 
pathic indication. We have often noticed the facility which 
patients having phthisis pulmonalis had for taking on albu- 
minuria. A few years ago this species of nephritis was con- 
sidered an incurable disease; now it is known to be amenable 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 203 

to remedies; especially have Apiurn virus and Mercurius 
proved very efficacious. 

Mercurius has a long-time reputation for curing catarrhal 
affections, especially when induced by cool evening air; also 
for syphilitic affections which have suggestive analogies in 
blood-deteriorating influences. 

We bring Mercurius forward as an ally to Apium virus, 
hoping that it may prove a remedy to abort or arrest the exu- 
dative stage of phthisis pulmonalis, in many instances. 

We suggest the higher potencies as the ones more likely to 
be beneficial in incipient phthisis. 

Clinical. — Case 1. — "A childless woman, set. 36, had pneu- 
monia two years ago; since then, after nursing a hectic hus- 
band, she has had all the symptoms of incipient consumption; 
she has been under allopathic treatment without receiving any 
benefit. Symptoms: internal soreness in the throat from the 
cough, with burning in the pharynx; the tonsils and uvula 
soft; gums red and swollen; swelling of the cervical glands; 
feeling during deglutition as if a plug were in the throat; 
hoarseness and roughness of the voice; burning and tickling 
in the throat; provoking cough; stools hard, in small pieces, 
pressed together; haemorrhoids, with occasional hemorrhage, 
followed by relief. Menstruation has been absent eight weeks. 
The cough is dry, tickling; slight expectoration of phlegm 
after three or four coughs, lightest during the day, increased 
before going to sleep and right after awakening, but hardest 
in the night between 12 and 2 o'clock. Frequent and difficult 
respiration, especially when going up-stairs, with stitches below 
the right floating ribs toward the back, running up as far as 
the place between the shoulder-blades, aggravated by cough. 
She cannot lie on the right side; feels best in the morning; 
flashes of heat alternating with coldness; worse in the after- 
noon, best when warm and quiet; stubborn. Gave Merc, sol. 1 , 
followed by aggravation until the seventh day ; then gradual 
improvement, followed by recovery. Menstruation never re- 
turned." — Loescher in Archiv, III, 1, 74. 



204 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

MYRTUS COMMUNIS. 

Lungs and Thorax. — Acute pains in the chest and pressing 
pains in chest. Pains in chest and throat with blood-spitting; 
also dryness of the throat. Stitches in the left breast, running 
through to the shoulder-blade, as they often occur in tuberculosis. 

Relieves where no other remedy could. 

Hepatization of the left lobe of the lung. 

Cough. — Dry hollow cough from tickling in the upper anterior 
lobes of the lungs, worse in the morning, less tickling in the evening 
Cough with tightness of the breast. 

Pehrson gives the symptom: "Cough with tickling in the 
chest." 

Accompaniments. — Pains in the joints, stomach, chest, and 
throat. Catarrhal fever with pain in the elbows and knee-joints. 
Great lassitude during the afternoon hours. 

Paue in Pathology and Diagnostics, page 183, mentions for 
indications in pulmonary phthisis : " Stitching pains in the left 
chest, from the upper portion straight through to the left shoulder- 
blade, worse from breathing, yawning and coughing." 

The myrtle has been introduced to our notice by the Ger- 
man physicians as a valuable remedy in pulmonary phthisis, 
and from recent observations made by Wahle it is fair to pre- 
sume it is to take rank among our very best agents, such as 
Sulphur and Phosphorus. Dr. Hering says if we wish to pro- 
vide ourselves with the remedy, "Take a bunch of the myrtle 
as it is everywhere cultivated in pots, put it in a bottle with 
alcohol, and in a few days the tincture will be ready to form 
the attenuations." It is said that some of our physicians in 
Philadelphia have used Myrtus in the 3d dilution with great 
success. 

Dr. C. C. Smith sends the following symptoms: "Stitching 
pain in left chest from upper portion straight through to scapula, 
worse on deep breathing, or when coughing," also, "burning pain 
in left chest, with throbbing, aching and tickling." 

Dr. Wm. E. Payne reports in the Halinemannian Monthly, 
Vol. VI, p. 356, a case of pulmonary tuberculosis in which the 
symptoms were greatly improved by Myrtus, and gave as 
leading indications for its use : " Throbbing ache and stitching 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 205 

pain in the left infra-clavicular region, extending thence through 
to the shoulder-blade, aggravated by making a deep inspiration. 
Sensation of burning in left chest." 

Most of the above symptoms are from Wahle. 

NATRUM MURIATICUM. 

Lungs and Thorax. — Sensation and pain in the chest as 
from tension. Vague pains in the thorax. 

Cough. — Cough seems to come from a tickling sensation in 
the throat, or pit of the stomach. Cough with sputum of bloody 
mucus ; or yellow blood-streaked matter. 

Aggravations. — Worse from rapid motion; from deep breath- 
ing; from lying down in bed and becoming warm. 

Accompaniments. — Weak voice; easily gives out from talk- 
ing (Stan.) ; morning accumulations of mucus in the trachea and 
larynx. Anxious oppressed breathing which is ameliorated 
by exercising the arms, and going into the open air. Stitches in 
the sides; bursting pain in the forehead; shocks or beating con- 
cussions in the head. Involuntary micturition (Caust, Phosph.). 
Stitches in the liver. Craving for salt. Chill at 10 A. M. Chlorotic 
appearance of face; palpitations which are worse from lying 
upon the left side. Great dryness of the mouth. Patients get 
worse at seashore. 

From our success of late in removing malarial cachexia with 
Natrum mur., we expect it will be found adapted to a class of 
pulmonary diseases where the malarial element is an import- 
ant factor. 

NITRIC ACID. 

Lungs and Thorax. — Soreness and constriction of the chest. 
Stitches in right side of chest and in trachea which feels as if a 
sliver was there. Cramp-like pains in chest. Soreness in chest 
as if ulcerated. 

Cough. — Dry, barking, from tickling in larynx and pit of 
stomach. Sputum is raised with difficulty; is sour, offensive, 
bitter, being yellowish and muco-purulent. Greenish-white casts, 
as if from air-cells. 



206 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Aggravations. — In the evening and when lying down. 

Accompaniments. — A characteristic sensation is pricking 
as from splinters; this is often felt in the throat. Loss of 
breath and speech from weakness (Stannum). Panting during 
work. Sensation of great weakness felt early in the morning, 
and sometimes in the afternoon. There is weariness and 
trembling throughout the body; chilliness on the back upon 
getting into bed; fugitive flashes of heat, usually in the cheeks 
or hands, unattended by thirst. Can endure but little covering. 
Profuse night-sweats. 

Pains get worse toward evening, especially the drawing pains. 
Dr. Dunham gives: Sticking pains in the rectum when coughing. 
Sometimes patients have extremely strong and offensive urine; these 
indications will be supported if there are hemorrhoidal tumors, 
fissures, or anal eruptions. 

It is characteristic of Nitric acid that the pains are not well 
borne. 

In grouping together the symptoms of this remedy we find 
many analogous to those attending the development and pro- 
gress of phthisis, particularly that variety of phthisis having 
its origin in syphilitic or mercurial poison. 

There are clinical verifications of its having cured cases 
where there was purulent expectoration accompanied with rat- 
tling in the trachea and nausea. 

PHOSPHORUS. 

Lungs and Thorax. — The action of Phosphorus is most 
marked upon the lower and middle lobes of the lungs. Guiding 
symptoms for its use are: great tightness across the chest. Con- 
gestion to the chest worse from any emotion. Burning and pierc- 
ing soreness in the chest. Pain in chest from coughing relieved 
by pressure upon the external walls. 

Cough. — Dry, tickling, with tightness across the chest. Cough 
provoked by soreness and tickling in the larynx. Hollow, nervous, 
spasmodic cough. Harsh, irritating cough, with muco-purulent ex- 
pectoration, or bloody muco-purulent expectoration, Cough which 
shakes the whole body. Cough provoked by a sticking sensation 
in the epigastrium, relieved by pressure. Cough with pain going 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 207 

from pit of stomach through to spine. Cough with stitches over 
one eye, with a splitting headache. Cough with hoarseness and 
aphonia. 

Aggravations. — When one enters the room ; from strong odors ; 
before a thunder-storm. Worse evening and just before midnight. 
When going from warm into cold air; from laughing, talking, 
eating, drinking ; from lying on left side or back. 

Ameliorations. — After sleeping (reverse Lach.) ; from lying 
on right side; from cold drinks. 

Accompaniments. — Goneness in region of the stomach ; 
painless diarrhoea, or long narrow difficult stool; puffiness 
around the eyes; bursting headache occasioned by coughing; 
apthous patches on roof of mouth or tongue. There is an in- 
clination to yawn; there is a free flow of watery urine when 
afflicted with pain; perhaps involuntary micturition when 
coughing. There is often loss of hair in spots. Night-sweats 
come on during sleep, and are clammy, more upon the head, hands, 
and feet. Chill without thirst, generally in the evening; chill 
alternates with heat. 

The disposition is irritable; mind over-active, and body pros- 
trated from the least unpleasant impression. The mind is by 
turns gloomy, mirthful, anxious or indifferent, but excitability 
is the rule. There is thirst, with a desire for something refresh- 
ing, and a great relish for cold milk, ice cream, etc. Phosphorus 
agrees with the hemorrhagic diathesis, and with blood-spots in 
the sputum or the discharges from the nose. 

We see the feebleness of the nerve-work or structure-control- 
ing power, the brilliancy of the mental faculties, the increased 
amatory excitement, attended with a steady emaciation, in 
our Phosphorus type. It agrees with the tall, lean and florid 
temperament, very different from the chubby, fat and lym- 
phatic temperament of Kali bichromicum, or the petite figure 
with chalky face, of the Calcarea temperament. 

Phosphorus is well adapted to slender or rapidly growing 
persons, to persons subject to hemoptysis, or to frequent bron- 
chial attacks with great debility ; also to those cases of tuber- 
culosis where there is a complication of fatty degeneration of the 
liver. 



208 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Those who believe tubercular diseases to be incurable, and 
but indifferently amenable to palliation even, will probably 
continue to doubt whether our cases reported as tubercular 
phthisis and cured by Phosphorus, were anything worse than 
cases of obscure pneumonia, after all. 

That Phosphorus is best adapted to those cases which most 
simulate pneumonia, or have tubercular deposit, provoked by 
old inflammations of the lungs, we are inclined to believe. 

Tubercular affections are not uniformly the same in totality, 
and the concomitants of tubercle are very important factors 
in selecting a remedy. 

The notoriety gained in certain quarters from the use of 
phosphate of lime and phosphate of soda in phthisis, goes to 
corroborate the testimony of physicians who report cures from 
Phosphorus, as Phosphorus is conceded to be the chief modify- 
ing agent in such cases; Phosphorus the great nerve-corrector, 
and lime the nutrient modifier, supplying all the curative ele- 
ments in the case. 

The types of constitution to which the phosphate of lime 
promises best results are : the nervous, scrofulous and rachitic- 
scrofulous, as seen in the caries of the bones, and tubercle with 
hemorrhagic tendencies, and tubercle with pneumonic and 
pleuritic complications, attended with great mental activity. 

Clinical. — Case 1. — " G. E., set. 34, machinist, temperate, with 
no hereditary predisposition to phthisis ; took cold four months 
ago ; found evidences of a left-sided pleuritis, with exudative 
products unabsorbed ; patient was emaciated ; chest contracted ; 
was without appetite and very weak, with tendency to diar- 
rhoea ; profuse night-sweats, and suffering from a continuous 
cough, worse in the morning, at which time there was copious 
purulent expectoration. Physical signs point to acquired 
tuberculosis of the left lung, there being a spot, size of the 
hand, dull on percussion, with hardly audible murmur, accom- 
panied with bronchial sounds more pronounced, and at another 
point cavernous rales and tympanitis; fever marked. Patient 
was put upon Phos. every other evening ; in six weeks cough 
and expectoration had much improved ; less dulness, rale 
more dry." — Lorbacher. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 209 

Case 2. — "P. S., set. 31, working in factory; lost father and 
one brother from tubercular affection of the lungs; suffered 
for the last four years with occasional hemoptysis ; short, dry 
cough and difficulty of breathing. Consulted me after a pro- 
fuse hemorrhage. Aconite and Bryonia had been taken. Pa- 
tient was a small, somewhat emaciated person, with flattened 
walls of the chest anteriorly; defective expansion during in- 
spiration ; dulness on percussion and abnormal murmur; bad 
dyspnoea on ascending the stairs, and a dry cough through the 
day and evening; expectoration towards morning, with pus; 
granules in the mucus, and night-sweats. Gave Phosphorus 30 , 
a dose every other evening for one month ; then repeated at 
longer intervals for a year or more ; disease three months later 
had so far improved as to admit of patient attending regularly 
to his labor. One year later a slight hemoptysis, which was 
easily controlled, but no progress of tubercular degeneration 
or deposition." — Dr. Lorbacher. 

Dr. Lorbacher like many others has found the more ad- 
vanced potencies better modifiers than the lower potencies. 

Our arrangement of clinical cases is somewhat arbitrary, 
growing out of our classifying phthisis under different heads. 
For a more extensive study of clinical cases the reader is re- 
ferred to our chapter on Caseous Pneumonia, or Pneumonia 
with Cheesy Exudation. 

PSORINUM. 

Lungs and. Thorax. — Pains in chest coming by fits, with 
great anxiety. Feeling as if there were an ulcer under sternum. 
Pain in the right hypochondrium when coughing. Chest inflates 
only with much exertion. 

Cough. — Dry cough, with shortness of breath, provoked by 
a tickling in the trachea ; coughs a long time before beginning to 
expectorate (Alum.). Sputa of green mucus. 

Aggravations. — From talking and from drinking. 

Accompaniments. — Sensation as if the throat were con- 
stricted, and has to cough to relieve the sensation. Dyspnoea, 
which is better in a recumbent posture, and worse from sitting up, 
and when the arms are brought near the body. Pain in right side 



210 PHTHISIS PULMONALIS: TUBERCULAR THTHISIS. 

worse from coughing; palpitation of the heart. Bodily excre- 
tions and exhalations have an offensive odor. Profuse sweats, 
and sweats from the least exertion at night, with great weakness. 
Feels restless before a thunder-storm. Bloody discharges from the 
rectum. Breath offensive ; odor like rotten eggs ; flatulence pass- 
ing the bowels which smells like sulphur. 

Clinical. — Case 1. — "Mrs. C. R., aet. 46, emaciated, hectic, 
exhausted ; cough loose, racking, spasmodic; expectoration copious, 
offensive, bloody, chiefly at night; violent, craving hunger, and 
sinking, gone sensation; craves hearty food, coffee, acids; dis- 
tress and unrest from flatus ; constipation ; copious, offensive leu- 
corrhea; pressure in vertex. 

" Fine gold-like threads before eyes ; dark illusions ; heavy sen- 
sation in right temple toward the right eye. Thirteen years ago 
the itch was suppressed by ointments ; the scalp itches occa- 
sionally without eruption. Psorinum 200 at the suggestion of 
Wm. P. Wesselhoeft brought out an eruption between the fin- 
gers ten days after, which itched violently, and cured the case." 
— C. F. Nichols, M.D. 

Case 2. — "A gentleman, set. 26, who had grown rapidly, of 
unmistakable consumptive habit, with bad family history. 
When a child had itch cured with unguents. In his nineteenth 
year had bleeding from the lungs, since then every year. Symp- 
toms : for eight years he has had occasional night-sweats ; fre- 
quently hoarseness, especially early in the morning. Cough at 
times dry, again with expectoration tasting like old cheese. It 
is hard for him to climb stairs, although he usually feels best 
while in motion. The right clavicular region and the infra-clavi- 
cular fossa yields a dull sound upon percussion. 

"Auscultation of the left and more particularly of the right 
anterior thorax, showed that inspiration was short and super- 
ficial, while expiration was comparatively deep. Gave Psori- 
num 5 , one dose daily ; after four weeks gain in flesh, increased 
activity, general improvement of every symptom ; appearance 
of an itch-like rash. Percussion sounds unchanged." — Leid- 
beck in Hygea, XIII, p. 579. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 211 

SAMBUCUS NIGRA. 

Lungs and Thorax. — Oppression of the chest with pressure 
on stomach. Suffocative attacks after midnight, with throwing 
abont of the arms and shedding of tears ; patient has to sit up in 
bed to get breath. 

Cough. — Cough spasmodic, hollow and dry ; very tormenting. 
Expectoration of small quantities of tough, yellow mucus, only 
during the day ; sometimes copious mucus, yellow and of saltish 
taste. 

Aggravations. — At about midnight; from head lying low; 
from dry, cold air. 

Accompaniments. — (Edematous swelling of the feet and legs. 
Hands and forearms bloated, and blue. Renal and cardiac disturb- 
ances. 

Paue gives : " Profuse sweats, but only when awake ; the skin 
becoming dry and hot during sleep." 

Hering mentions that "In Sambucus cases, inhalation is reg- 
ular, but sighing attends exhalation." 

C. C. Smith sends : " Patients can inspire, but expiration is 
difficult." 

We have met a class of cases in phthisical families where 
there seemed to be early tendencies to dropsical complications. 
Such have looked sallow in the face, and bloated about the face 
and limbs. We remember in particular the case of a woman 
past 40, whose children had all died of phthisis, who herself 
showed marked tendencies to dropsical complications and really 
broke down more from troubles affecting the heart and liver 
than the pulmonary structures. 

The following are typical cases: 

Clinical. — Case 1. — " Woman, set. 32, constant cough, copious 
expectoration of salty taste; loss of strength; increasing dysp- 
noea; cough with pain in chest; legs cedematous as far as above 
the knee. * 

March 26th, she received tinct. cort. Sambucus nigra, one 
dose each day. 

I saw the patient after six days and had every reason to be 
pleased. The constant cough had been easier, the arterial 
excitement was less, a four hours sleep had given her new 



212 PHTHISIS PULMONALIS: TUBEKCULAP PHTHISIS. 

courage and the OBdema had descended below the knee. The 
patient said the remedy had acted especially upon the urine 
and skin, for she had been obliged to urinate three or four 
times each night and there had been an itching all over, which 
she had never before had. The remedy was repeated every 
other morning, — improvement progressed daity, the oedema 
grew less and less, and could hardly be noticed in the morn- 
ing; cough and expectoration became more rare and the dysp- 
noea lessened as she grew stronger; the urine which under the 
action of the first six powders had deposited a copious fetid 
sediment, commenced to look clearer; in spite of the stubborn 
itching, no rash showed itself, but the epidermis scaled off with 
violent itching. May 12th, I found the convalescent busy 
about her home duties." — Schueler in Arch. XIV., 3, 34. 

Case 2. — "Male, set. 20, of strong constitution. After drink- 
ing of cold water, inflammation and fever, violent cough and 
expectoration; after several remedies had been given without 
affording him relief, he was in the following condition : press- 
ing pain in the chest; cough torments him day and night, with 
copious expectoration of nasty, sweetish taste; pale, earthy ap- 
pearance of countenance; emaciation; rapid, weak pulse; burn- 
ing heat in the palms of the hands ; much thirst in the P. M. ; pro- 
fuse night sweat; tongue lightly coated; bowels regular; appe- 
tite, which at first had been good, is now quite gone. Gave 
tinct. cast. Samb., one drop, 3 times a day. After the first two 
doses relief; cough and expectoration were far better; appetite; 
after 14 days the pain in the chest and the sweats had left him. 
A perfect cure followed." — Schulz, Pr. Beitr. II, 185. 

SANGUINARIA CANADENSIS. 

Lungs and Thorax. — Pain in the right chest to shoulder 
(Kali bichrom., left, Myrtus, Sulphur), affecting the muscles so 
the arm is raised with difficulty to vertex. Heat in right chest 
passing down to stomach and perhaps to abdomen. Great sore- 
ness in chest from coughing. Burning in chest. 

Cough. — Cough dry, often excited from a constant tickling 
at entrance of larynx, also from tickling in stomach, and from a 
crawling sensation behind the sternum. Cough often awakens one 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 213 

at night and compels the erect posture, and ceases on the passing 
of flatus upward or downward. Sputa bad-smelling, noticed even 
by the patient. 

Accompaniments. — Flushes of heat passing over the body, or 
heat flying from head to stomach, or chest to stomach, are very 
characteristic of Sanguinaria. The fever is most apt to appear 
at 2 or 3 o'clock, P.M. daily, and with circumscribed redness of the 
cheeks; this redness simulates peculiarly that which is almost 
always present at some stage of a pulmonary phthisis. Pulse 
quick and small ; hands and feet burning ; breath short ; heat 
after coughing spell; yawning; belching of wind, and passing of 
flatus from the bowels; night-sweats and diarrhoea. There is an 
empty feeling in the stomach, which eating aggravates rather 
than relieves. Patient dislikes motion. Some authors think 
Sanguinaria controls the heart's action as does Digitalis; our 
provers speak of frequent palpitations before vomiting, with a 
sense of great weakness. 

We are convinced from experience that this remedy has not 
received the attention from the profession which it deserves. 
We were cured with it ourself of a very teasing and debilitat- 
ing cough which had lasted four or five weeks, and had with- 
stood other remedies. There was much tenderness in left chest 
under third rib, with soreness, burning and smarting worse when 
we coughed. Cough was dry, voice weak, with a feeling of gen- 
eral prostration and weakness, as with a slow fever. It is to be 
noted that the trouble was in the left lung in our own case, 
while a majority of provers say the action of Sanguinaria is 
chiefly upon the right lung. 

Dr. Hoi combe speaks of it for a harassing cough with marked 
inflammatory action, where you are uncertain whether you are 
dealing with a chronic bronchitis or an incipient tuberculosis. 

Dr. C. C. Smith speaks of it as a remedy in syphilitic affec- 
tions of the lungs. He also sends the symptom : " Desire to 
take deep breaths, followed by intense pain in right side of chest, 
and morning lassitude." 

Clinical. — Case 1. — "M. has coughed more or less for years, 
but more during the summer ; a year ago he had pneumonia, 
after which his cough sounded suspicious; he cannot lie down 



214 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

but sics up ; his countenance is bloated, his pupils somewhat 
enlarged, his pulse small and quick ; night-sweats, diarrhoea, 
pain in the legs, pain in the chest, every attempt to breathe is 
accompanied with a murmur (rauschen) in the chest, followed 
by cough ; otherwise the cough comes in paroxysms of very copi- 
ous expectoration of fetid pus ; the breath also is very fetid (Psor.) 
and disagreeable even to the patient. Choking with the cough ; 
before and after coughing, spasmodic hiccough; with the cough a 
beating, and feeling of tightness in the head. After cough heat 
continues some time ; after the heat, yawning and stretching. 

" Gave Sanguinaria 3 , one dose evey two days ; after this con- 
stant improvement. 

" The fetor of breath and expectoration disappeared alto- 
gether. Lessening of the expectoration, which a few days ago 
were streaked with blood ; he can lie horizontal once more 
and walk about during the day." — Hempel and Arndt's Mat. 
Med. from Bute in N. Arch. II., p. 148. 

SEPIA. 

Lungs and Thorax. — Oppression of the chest and shortness of 
breath from exercise. Stitch in left chest and scapula when 
breathing or coughing ; soreness in the sternal region of the 
chest ; congestion of blood to chest. 

Cough. — Dry cough at night until midnight, accompanied fre- 
quently with nausea and vomiting of bitter substances ; coughs 
till breath is gone and then gags or vomits. Coughs through 
the evening, only stopping when the cough loosens, so as to expec- 
torate a little phlegm; cough with blood-streaked expectoration 
after dinner ; expectoration in the morning of green or gray puru- 
lent matter, generally of a saltish taste ; sometimes the taste is 
putrid and the breath fetid. (Psor., Sang.) 

Aggravations. — When at rest; when lying on left side 
(Natr. mur., Phos., Lycop.) ; from use of acids. 

Accompaniments. — Palpitation ; fatigued badly by a short 
walk. Face pale and sallow with pimples, particularly upon 
forehead and tip of nose. Falling off of hair ; disposition to take 
cold from dry, cold winds, and from getting the head wet. Night- 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 215 

sweats ; sweats most upon the back and thighs, moving downward 
upon the calves ; sweat smells sour or offensive; urine also offensive. 

Clinical.— Case 1.— "Miss M. J. H., set. 28, dark brunette, 
sisters died of consumption ; has had affection of the lungs 
with hemoptysis and cough for six years ; often troubles her 
now when she is obliged to exert herself as a nurse, but the 
cough is less since the appearance in the face of a red papular 
eruption, now existing for two years ; it consists of a hard papula 
on a red base without suppuration, on her cheeks, forehead, nose 
and chin ; characterized by burning, itching and smarting, espe- 
cially in wet, cold weather ; menses too often and too profuse. 
Lung troubles were : a dry, hard cough most of the time, with 
slight expectoration on rising in the morning; much desire to 
clear the throat of phlegm which cannot be raised ; has an op- 
pressed feeling through the lungs after a hard fit of coughing; 
says her cough seems to come from her stomach, which feels 
as if scraped. Sepia 200 , two doses, removed all symptoms per- 
taining to the chest, and for a long time, and we know not but 
to the present." — C. Wesselhoept. 

This may be studied with Dr. Hitchman's case, reported 
elsewhere. 

Case 2. — " A man of forty years, small and phthisicky, had 
been bedridden with consumption for six months. During 
December he received Phosphorus with good results, then Cal- 
carea 12 , then Lycopodium 12 , with improvement until the middle 
of April, when he had come to a standstill, he received Sepia 30 ; 
after this there was a constant improvement in the lung until 
the end of May ; the patient could lie equally well on the back 
and on the sides and was no more troubled with night cough, 
nor did he cough much during the day ; the expectoration had 
lost the appearance of pus and showed only white bronchial 
mucus ; there was such a wonderful improvement in his con- 
dition, that no one would have recognized in him the formerly 
hopeless case; he resumed his occupation as shepherd and 
bore much fatigue and overheating." — Hempel and Arndt's 
Mat. Med. from Gross in Archiv. VII, 2, 30. 

Dr. Gregg attaches much importance to the symptoms : ex- 
pectoration free in the morning, or expectoration at night, but not 



216 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

during the day. Also, stitching, darting pains through the central 
portion of the right lung. 

Raue mentions that the cough is better when lying down. 

SILICEA. 

Lungs and Thorax. — Excruciating deep-seated pains in chest. 

Lungs feel sore. General sensation of weakness in chest (Stan.) ; 
has to use the whole chest to speak. Stitches in sides and chest 
going through to back. Tickling itching in the region of the 
supra-sternal fossa which threatens suffocation, until a deep shat- 
tering cough comes on, which lasts several hours. 

Cough. — Deep, exhausting; at first dry, thin, loose, with co- 
pious purulent sputa. Cough produced by tickling in throat-pit ; 
awakening him at night. Sensation as of a hair lying from tip of 
tongue to trachea, compelling him to cough, hack and scrape. 
Sputa viscid, milky, frothy, tasting greasy; or more often dense, 
muco-purulent, composed largely of pus globules of musty odor, 
possibly fetid. 

Aggravations. — By cold drinks (Rhus) ; by motion ; by speak- 
ing ; by lying down. 

Accompaniments. — Great shortness of breath from exercise, 
and from lying on the back ; hoarseness in the morning (reverse of 
Phos.). Cough is often accompanied by swelling of sub-maxil- 
lary glands. Often there is vomiting of tenacious mucus in the 
morning. Want of animal heat, always chilly even when exercis- 
ing. Face and head sweat on the least exertion. In later 
stages of phthisis, there is often violent general heat with violent 
thirst in the afternoon, evening and all night ; or periodically re- 
turning heat during the day without previous chill, followed by a 
slight sweat. Night-sweats, mostly after midnight, which are 
sour or musty, or of a cadaverous odor. Periodical sweats at 6 
a.m., 3 to 5 p.m., and 11 p.m. Stool watery, containing undi- 
gested food, weakening ; or hard and difficult to expel, from in- 
activity of rectum. Stool recedes after partial expulsion. Pa- 
tient has great aversion to warm cooked food, especially to meat. 

The well-known power of Silicea over suppurative processes 
and septicemic action would lead us naturally to suppose such 
power might be utilized in the purulent stages of tubercular 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 217 

action, and so it has proved. Probably the advanced stage is 
the more appropriate time for its use ; yet if Silex can develop 
tubercular exudation, as has been supposed, why may it not 
cover the earlier symptoms as well as the later ? Possibly the 
tubercular deposit which has followed the breathing of quartz 
dust, may have been more from mechanical irritation produc- 
ing inflammation as any foreign body, the tubercular exuda- 
tion following the inflammation. There is a cachexia, how- 
ever, to which Silicea corresponds, and it may yet be deter- 
mined that it is as much a modifier of the tubercular diathesis 
as Calcarea carbonica or Calcarea phosphorica, only varying 
in its type. Hughes regards it as suited to organic changes, 
rather than to functional disorders; says it is even more im- 
portant than Calcarea for rachitis in children. 

It has a powerful action upon the lymphatic glands, pro- 
moting dispersion or maturation, and as it has cured epilepsy 
it must have a marked influence over the nutrition of the nerve 
centres, which, if phthisis comes of loss of nerve force as man 3' 
think, tends to show still further its range of applicability. 
The low grade of vitality indicated by the impossibility to 
keep warm, or get warm even when in motion, has much ana- 
logy to some forms of tuberculosis. 

Clinical. — Case 1. — Mr. T., set. about 30, of a sanguine- 
bilious temperament, rather dark complexion ; five feet, ten 
inches high ; weight in health, 160 lbs. ; family consumptive, 
two sisters and a brother having already died, leaving a brother 
still enjoying tolerable health. Had severe hemoptysis in the 
summer while in the hayfield and had constantly declined 
from that time. Saw him the April following, he having 
passed through the hands of several physicians and at that 
time was so low that his ph3 7 sicians said he could not live six 
weeks, and such was my opinion on seeing him. There was a 
large cavity in the right lung at the second intercostal space at 
about three inches to the right of the sternum; there were 
heavy rales in the left bronchi, with decided indications of 
breaking down of the parenchymatous structure, and cavern- 
ous lesions there also ; the sputa was very heavy and largety 
purulent; there was the odor of the cadaver already present, 

15 



218 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

musty and offensive enough from septicemic influences ; he 
had no appetite, and sat up hardly longer than to have his 
bed made ; skin had a cold, clammy feel and he was drenched 
with night-sweats. Case was marked with absence of vital 
warmth — indeed, so forbidding was the case that I refused his 
brother when he asked me to visit him again in a week ; he 
lived forty miles away; he was given a dose of Silicea 2000 every 
other night with Sac. lac. and ordered to report by mail in a 
week. He had been very much harassed with his night-sweats 
and cough which was worse from motion; the first mail brought 
me the intelligence that medicine acted like a charm and 
wanted more of the same kind. I sent so that he got a dose 
of Silicea twice a week and so treated him till June when he 
paid me a visit. Left lung appeared -to be cleared up; night- 
sweats no longer troubled him ; appetite was good ; was stead- 
ily gaining in flesh and strength. Nevertheless, in the right 
lung there yet remained traces of the vomica which now was 
much smaller and secreting only a small amount of muco- 
purulent matter; he was furnished additional medicine and 
went home and by the middle of July was on his mowing ma- 
chine. Patient was alive four years after and enjoying fine 
health and I do not know but he is to-day ; no man could be 
more surprised than myself at these results. Were we all de- 
ceived ? Three good physicians of the leading school of medi- 
cine agreed about the diagnosis and I don't think there is left 
a possible ground for doubt. The case is exceptional we agree, 
but is it not full of suggestions ? — G. N. B. 

SILPHIUM LAC. 

This is a remedy lately brought to the notice of the profes- 
sion, and for excessive secretion of mucus and the serous ele- 
ments is invaluable. I do not know that we have any extended 
proving of the drug, and hence indications for its use are mostly 
drawn from clinical sources. It resembles Stannum as to the 
abundance of the expectoration, but it differs from Stannum 
in that the sputum to which it corresponds is more watery, is 
tasteless, and the mucus mingled with the watery elements is 
stringy and light-colored. If it be slightly purulent it does not 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 219 

seem to be contraindicated. Usually Stannum sputa offer 
much more consistence, are of a yellowish or greenish-yellow 
hue and sweet of taste. We have met cases where there was 
little of the yellow cast, the principal mass, which surpassed 
in quantity anything we had ever seen, being of a tough, 
ropy, glairy consistence, like the white of an egg, not watery at 
all. Silphium has not the gone feeling of Stannum, nor has 
it the concussive paroxysms of coughing. It has the symptom 
of exhaustion peculiar to our cases of phthisis. The guiding 
symptom then is, excessive expectoration of a thin watery mass, 
with stringy mucus floating in the more liquid elements, which may 
also be slightly purulent. 

Dr. W. T. Laird, of Augusta, Maine, writes me that he has 
prescribed it in numerous cases, where such symptoms were 
present, and always with satisfactory results. " It always di- 
minishes the amout of expectoration and contributes greatly 
to the relief of the sufferer." 

Clinical. — Case 1. — "Mrs., M. set. 39, lymphatic tempera- 
ment, in the last stages of catarrhal phthisis; large cavities in 
both lungs; pulse 120 to 140; hectic fever and night-sweats. 
The most pronounced and troublesome symptom was a slight 
cough, day and night, preventing sleep, with a constant, pro- 
fuse expectoration of water mixed with light colored, stringy, taste- 
less mucus, containing a few pus globules. The amount raised 
in twenty-four hours was nearly three pints by measurement. 
Silphium 30 afforded marked and rapid relief. In less than a 
week the sputa had diminished to half a teacupful per diem. 
The appetite improved and there was a slight gain in flesh 
and strength. The disease, however, had made too great pro- 
gress to be arrested and patient died three months later." — 
W. T. Laird. 

This is a very instructive case and shows pointedly the 
curative action of the remedy. The question naturally arises 
if we can arrest for a time the progress of a disease, why we 
may not hope to bring to the aid of such reaction the means 
necessary to complete a cure? Was this case supported by all 
that diet could do? Were there not new indications by which 
the remedy to follow Silphium could be selected? Dr. Laird 



220 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

has the thanks of the profession for what he has done. Is it 
not just possible, however, that he yields the ground too soon, 
in saying that his remedy cures no case of phthisis, leaving 
us to infer that he thinks the disease incurable? 

STANNTJM. 

Lungs and Thorax. — Empty feeling in chest, or great weak- 
ness in sternal region. Sore feeling in the chest; stitches in left 
side of the chest when breathing, or when lying on the left side. 
Tendency to hemoptysis. 

Cough. — Dry, concussive, apt to be in three paroxysms ; short 
cough from time to time, as if from weakness of the chest; desire 
to cough as if from sense of constriction. Cough and expector- 
ation followed with great weakness of chest and voice ; too weak 
to talk. Cough with copious sputa, glairy mucus, like the white 
of an egg, streaked with yellow or greenish-yellow pus; sputa also 
yellowish-green, tasting sweet or saltish, sometimes sour and 
raised most abundantly in the morning. Very abundant sputa a 
leading indication. 

Aggravations. — By singing, laughing, lying on the right side 
(reverse Phos., Lycop.), and by warm drinks (Phos.). 

Accompaniments. — Reading aloud or talking produces 
great exhaustion; great weakness of the legs; patient drops into a 
chair, instead of sitting down with ease. Oppressed breathing 
when lying down, more in the evening, increased by movements. 
Chill at 10 A.M. (Nat. mur.), with numbness of finger-tips, or 
in the evening over the back; chill slight but with chattering of 
teeth. 

Burning heat in the hands evenings; hectic fever; sweats 
night and morning, and most profuse on the back; perspiration 
smells mouldy (Sil.). 

Pulse frequent and small, trembling. 

The reputation which Stannum has gained in the cure of 
consumption can hardly be based upon mere accident, though 
to what extent it is able to disperse tubercle when existing, we 
are not yet fully persuaded. It seems to cure both catarrhal 
and scrofulous consumption. We incline to the opinion that 
its greatest service will be found in cases largely catarrhal 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 221 

which have been grafted upon a scrofulous habit; tubercle 
affecting more particularly the mucous membrane would be 
its most effective plane. 

In our own experience it has corresponded to an abundant 
secretion of mucus relatively, even when muco-purulent, tlie 
empty feeling in the chest an important characteristic. 

Clinical. — Case 1. — "A gentleman, set. 36, of a phthisical 
habit with hereditary consumption in the family, pale, ema- 
ciated, breathing short and puerile; troubled with a cough 
which is sometimes dry, but morning and evening coughs up 
a greenish-yellow matter of a sweetish taste. The physical 
signs are flatness of the thoracic walls, diminished resonance 
and broncophony; has headache, aggravated by the cough; 
small stools and urging at the rectum ; hands cold and feel 
heavy; feet cold and oedematous; hectic flushes; much thirst; 
appetite good, but food disagrees ; eating followed by pain in 
the epigastrium; cured in a few weeks by Stannum." — Hitch- 
man. 

Case 2. — A Mrs. Powers, set. about 40, abandoned by two 
physicians to a hopeless phthisis of the lungs; she had had a 
hard swelling upon the neck a few months previous to com- 
mencement of her chest troubles; discussed with iodine by 
advice of her physician; found her with a pulse of 160, small 
and trembling; physical examination showed dulness in the 
upper portion of right lung and voice sounds at the middle of 
third intercostal space three inches to the right of the sternum ; 
heavy rales as of air passing over quantities of matter in a 
fluid state ; cavity seeming of unusually large size, although 
expectoration was not so heavily purulent; the quantity ex- 
pectorated, however, was simply enormous; estimated to be 
fully a quart for every twenty-four hours ; much of this was a 
thick glairy mucus, streaked with greenish veins or yellowish- 
green ; there was a weak feeling of the chest, and voice was 
weak; raised more in the morning, coming up by severe 
coughing turns, and sputa tasted rather sweetish, sometimes 
salt; both the walls of the vomica and the bronchial mucous 
membranes must have been active secreting points to have 
furnished such quantities of matter. I first gave Calcarea 



222 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

carb., which was not the simillimum; pulse fell to 123, and 
expectoration fell off about one-fourth; no additional improve- 
ment followed the medicine; three weeks, later I gave Stan- 
num 3 , and six doses cured the case, given at increasing inter- 
vals for six weeks. — G. N. B. 

STICTA PULMONARIA. 

Lungs and Thorax. — Pulsations at right side of the sternum, 
going down to epigastrium. Oppressive pain in left thorax un- 
der fourth rib. Oppression in the chest as if a hard mass were 
there. 

Cough. — Hard, racking cough provoked by inspiration; dry- 
cough in the evening and at night; loose cough in the morning 
with more scanty expectoration as the day advances. Incessant 
wearing, racking cough in consumptives. 

Aggravations. — In the evening and from lying down. 

Accompaniments. — Splitting frontal headache. Pain in left 
side below scapula. Tickling in bronchi and larynx. Rumbling in 
abdomen with pain from sternum to spine. 

SPONGIA. 

Lungs and Thorax. — Congestion in chest from least exertion. 
Burning, soreness, and sense of great heaviness in chest. Stiches 
in both sides of chest. Tuberculosis in apex, of left lung. 

Cough. — Chronic cough attended with violent paroxysms, in 
which small hard tubercles are thrown off. " Cough dry and sibi- 
lant, sounding like a saw driven through a pine board; each 
cough corresponding to a thrust of a saw." 

Aggravations. — From eating sweet things ; from cold drinks ; 
lying with head low; in a warm room; in dry cold winds and 
from excitement. 

Ameliorated from taking warm food or drinks. 

Accompaniments. — Motion exhausts one particularly in the 
chest; sudden attacks of weakness while walking, which causes one 
to totter, while the blood seems to rush into the chest as if some- 
thing would burst. Severe dyspnoea, relieved by bending body 
forward, worse from lying down. Voice gives out in talking or 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 223 

singing. Suffocative attacks; throat symptoms relieved by re- 
cumbent posture. Nausea with faintish weakness. Canine hunger, 
and swollen thyroids. 

SULPHUR. 

Lungs and Thorax. — Dulness on percussion ; sensitive thoracic 
walls; sore spots in the chest; soreness in upper portion of left 
lung going through to scapula (Myrtus). Pain in scapula and right 
intercostal spaces when coughing. Lungs feel as if they touched 
the back. Pressure in the chest; contractive pain around the chest, 
sensation as of screwing together in the chest. Cutting and burn- 
ing deep in the chest after a walk in the open air. 

Burning in chest with heat arising to face. 

Feeling of coldness in the chest; sometimes as if a lump of ice 
were in the right chest. Rattling in the chest. Weakness in chest 
when talking. 

Cough. — Dry, short, violent; occurs both day and night, but 
apt to present typical periods early in the morning or on going 
to bed. Dry cough with hoarseness, worse nights. Sometimes 
patient wants to cough, but is not able. Much coughing at 
night on going to bed (Hepar), with heat in the head, especially 
crown of the head and face. Cough caused by mucus in the 
bronchi, morning mostly when the air passes over into the air- 
cells. Painful shocks in the head when coughing. 

Sometimes there is a loose cough with soreness in chest, or 
pressure with expectoration of thick mucus; vomiting when 
coughing (Bry., Sep.). Much rattling of mucus in the lungs. 
The cough worse in the morning, relieved by sitting up 
(Spongia). In one case we noted aggravated by Sulphur; there 
was great rattling and difficulty of breathing with considerable 
expectoration, yet not enough to begin to clear the bronchial 
passages. Cough frequently seems to be provoked by an irri- 
tation at the ensiform cartilage, especially when the cough is ac- 
companied by gagging, and head symptoms. Sulphur has 
proved curative in coughs attended with expectoration of blood 
mingled with pus; with sputa consisting of greenish lumps, or of 
thin, milky fluids, mixed with pus-globules ; and with putrid sourish 
sputa offensive to taste and smell (Psor. Sang.). 



224 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

Aggravations. — From talking; from eating; from taking 
air in upon the lungs (Natr. mur., Phos.); from walking in the 
open air. 

Accompaniments. — The throat is apt to feel rough and dry 
with a burning sensation in the trachea. There is sudden arrest 
of breathing when turning in bed. There is unsteady gait and 
trembling of the hands. Chill occurs at any time in the day, 
but more likely to occur in the evening; mostly internal and 
without thirst; the chill may be external with internal heat at the 
same time. Another phase is a chill with thirst preceded by 
heat; the chill often begins on the back of the hand or on the toes 
and runs up the spinal column. Again we have flushes of heat 
coming frequently followed with a slight perspiration and faint- 
ish feeling; burning palms and soles are quite characteristic. There 
are profuse sour-smelling sweats the whole night; or sweats in 
the morning, and in the evening ; in the evening mostly on 
the hands; in the night on the nape and occiput. Cramps in 
calves of legs at night, and in feet — inclined to put feet out of 
bed because of heat. 

There may be many associated symptoms, such as diarrhoea 
driving one out of bed in the morning; hunger and faintness at about 
11 A. M.; heat on the vertex; itching upon the integuments, or at 
the throat and anus, which gets worse in bed; disgust amounting 
to nausea about any effluvia coming from his own body; head symp- 
toms worse after dinner, inclination to vertigo with falling to left 
side; freckles and black pores on the face; smell before the nose as 
of an old catarrh, wants the doors and windows open for want of air. 
Drowsiness in the day-time and wakefulness at night. Chronic con- 
stipation with hard, dark and dry stools, requiring much strain- 
ing to expel (this last symptom was noticeable in one of our 
cases reported below) ; soreness, excoriations, exudations and 
itching of the anus; lancinating pains in anus; fistula in ano and 
haemorrhoids. 

The rank the great Hahnemann gave to Sulphur as an 
anti-psoric, or exterminator of the root of -chronic diseases is 
none too great, and well illustrates the acuteness of the man's 
observation and the scope of his generalization. We knew 
little of the power of the remedy till we had been in practice 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 225 

many years, and feel that we very poorly know how to teach 
the conditions that govern its higher functions now. In con- 
sumption everything depends upon the potency; the lower 
potencies are vile or pernicious. I once provoked fatal activ- 
ity of the secreting vessels in a pulmonary consumption with 
a third potency, so that my patient was absolutely drowned 
out. We must caution against too frequent repetition and too 
low dilutions of Sulphur in pulmonary phthisis. Fincke says : 
" With single doses of Sulphur 55m , I have cured numerous cases 
of incipient phthisis." Our most pronounced cures have been 
with the 100 m , Fincke; one hardly less pronounced with 2G m , 
Fincke ; and how this is we are unable to say ; 200th and the 
6th had been tried with no results in one case ; lastly, this case 
was cured with a single dose of 20 m , Fincke. It is almost too 
much to believe, but we must report the facts let the reason be 
found out when it may; there is still something for us to learn. 
We have spoken of Sulphur as an anti-psoric from the Hahne- 
mann standpoint ; a term to express a diathesis productive of 
tubercle and other chronic morbid phenomena. The action 
of Sulphur seems to be primarily upon the sympathetic system 
of the nervous chain, or the seat of organic life; under the 
guidance of the ganglia of this system of nervous force the 
processes of nutrition and alimentation go on; the functions 
of the stomach, liver, pancreas, spleen and mesenteric glands 
are all modified by the action of Sulphur operating through 
this ganglionic chain ; it acts upon the skin and entire mucous 
membrane. Acting upon the glands and follicles as it does, it 
is easy to explain its great power as an absorbent, suggesting 
that it can be utilized in the matter of drainage of the system. 
The taking up of debris and adventitious products and causing 
their elimination out at the natural sewage, is most important 
to health. As an electric it is negative to all known substan- 
ces and the exact opposite of oxygen, which is positive to all 
known substances ; this may be of more significance than we 
think. I should place the service of Sulphur then largely as 
that of an eliminating element. Substances refused by the 
morphic or structure-building forces need to be removed and 
carried out at the waste-gates of the body, such as the skin, 



226 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

lungs, kidneys and alimentary tract; broken-down structure 
or the refuse left from the combustion which liberates force, 
has to be conveyed away by these same channels. In tubercle 
we have exudation of albumen, the substance produced by the 
first processes of digestion; as Sulphur acts upon the entire 
class of functions operating to produce albuminoid and fibri- 
noid products, it is fair to presume that it can be utilized in 
molecular movements antecedent to the deposition of tubercle, 
and further acting as our most efficient agent in removing 
certain kinds of exudation, notably albuminous and fibrinous, 
it is fair to presume that it can be utilized to remove tubercular 
exudation. Wurmb, in his studies of pneumonia, has based a 
successful generalization for the use of Sulphur upon patholo- 
gical anatomy, and it is about the only generalization of the 
kind ever made. "If pneumonia," he says, "be not compli- 
cated with other diseases, then generally there comes a period 
when the febrile storm subsides; the pains, the dyspnoea, etc., 
cease — in short, the patient feels himself greatly relieved as 
soon as the infiltration has become complete; at this period 
art can have no other problem than to support nature ; while 
she, for the sake of removing the exudation, increases the ac- 
tivity of the processes of absorption, or on the other hand to 
oppose nature in case she shows a disposition to get rid of the 
pneumonic infiltration by a purulent degeneration. Now in 
our view no remedy yet proved corresponds so well to these 
indications as Sulphur; none compares with it in point of 
certainty and celerity of action. Sulphur penetrates the entire 
organism even in its finest and most recondite portions. It 
increases the activity of vegetative life generally, and the pro- 
cesses of secretion and absorption in particular; it accelerates 
the interchange of elements and makes it more pervading; in 
a word, it fulfils all the demands upon which the removal of 
an abnormal product is conditional. Upon these grounds we 
apply Sulphur to the removal of pneumonic infiltration of 
serous exudations of old as well as recent deposits in the skin, 
the parenchyma, the joints and bones." That it does remove 
pneumonic infiltrations no one denies; that it does remove 
tubercular exudation I am almost as positively assured. The 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 227 

products of pneumonic infiltration, or hepatization are unlike 
the exudation called tubercle; both, however, are the products 
of inflammation, and pneumonia supervenes upon tubercular 
irritation, and it would appear that tubercular infiltration 
often follows pneumonic inflammation. Persons subject to 
repeated attacks of pneumonia usually die of phthisis; to this 
fact our attention should be carefully given; if the same gen- 
eralization made by Wurmb in relation to pneumonic infiltra- 
tion should finally be found to apply to tubercular infiltration, 
science surely will have made a point and humanity have 
cause for thankfulness. The generalization founded upon the 
scrofulous diathesis, the evidences tending to show exudative 
obstructions and temperamental and antecedent peculiarities, 
governed our choice in two of our phthisical cases more than 
any pathogenetic symptoms we were able to gather up. There 
was concurrence, but too much generality to get at sharply 
defined indications. This ver}^ breadth of impression may be 
a valuable symptom ; molecular movements like the begin- 
nings of a great storm may be slow and cumulative, but all 
the more significant for the wide scope and sphere of the 
movements. In our cases of phthisis we are to study heredity, 
the forces of nutrition and the functions of elimination pro- 
foundly; we are to examine by physical and other signs for 
impediments from exudative matter. Conjoining our patho- 
logical studies with the study of our provings, we shall render 
the best possible service to our patients. We formulate the 
proposition that as the ganglionic system is the primary and 
fundamental seat of life, it is presumable that the hereditary 
elements of disease are contained here. The action of Sulphur 
being so energetic upon the system, more than any other 
remedy it may be expected to meet and overcome the tenden- 
cies to degradation of morphic forces in the nascent state, even 
to the removal of hereditary influences. 

Clinical. — Case 1. — Mr. P., set. 33, nervous-bilious tempera- 
ment, with blue eyes and light hair. Grandfather, several 
aunts and an uncle had died of consumption, also mother and 
three sisters; the latter, all the sisters he had, died before reach- 
ing the age of 25. 



228 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

He began to decline with the following symptoms: severe, 
dry, irritating cough which after a while ended not unfrequently 
in gagging and spitting up a little tough mucus, or ejecting 
from the stomach a little sour fluid; was much troubled with 
pyrosis, little desire for food, and if eaten attended with much 
distress; emaciated quite rapidly, and became despondent 
under the impression that he would soon follow those of his 
family, who had already died of consumption. Bowels were 
badly constipated; dullness of lungs on percussion, and atten- 
uation of the thoracic muscles strongly supported the inference 
of tubercle in the parenchymatous structure of the lungs ; two 
or three remedies were tried with no apparent results, certainly 
no curative results. At this time I concluded to take the con- 
stitutional diathesis as the basis of my prescription, and gave 
Sulphur l00m , medicating three powders and giving one with in- 
structions to take one each week. At this time patient looked 
sallow and haggard in countenance; had been afflicted with 
an inveterate constipation for nine months, an aggravated 
dyspepsia accompanying the harassing cough and more re- 
cently night-sweats. When my patient called upon me again 
in three weeks he was so much changed as to astonish me; 
his constipation had given him no trouble whatever from the 
time he took the first dose of Sulphur, indeed, the whole mor- 
bid chest and abdominal symptoms were rapidly passing 
away ; he got three or four more powders of Sulphur in the 
next six months and was discharged cured, and has so re- 
mained. I think there was no question about the character of 
the disease or the fatality that would have followed in a few 
months, had not curative action been established ; there were 
no cavities in this case and of coure no septicemia, and yet it 
is a very suggestive case when put with two or three more 
which will follow. — G. N. B. 

Case 2. — Miss C, milliner by trade, set. 30, of sanguine nerv- 
ous temperament, family consumptive, has had a dry cough 
for several months and been getting weaker and weaker grad- 
ually; been under the charge of a homoeopathic physician a 
long time. At our first visit found her just able to be about, 
but had given up all business; apex of left lung was dull from 



PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 229 

above third rib, and rales could be heard from a small cavity 
opening there, also voice sounds; was expectorating a small 
amount of muco-purulent matter which was raised with diffi- 
culty ; cough much more of a dry than a loose character. She 
had stitching pains going through from the front of the upper 
left thoracic region to the scapula, and was sore in front from 
pressure and tender from percussion ; had hectic fever with ac- 
companying chills and sweats, though sweating was not so 
marked as in some cases. On consulting with her physician, 
found that many remedies had been tried — Sulphur low and 
also 200. I said, I saw but one remedy indicated, and if 
Sulphur would not help her, knew of nothing to be done, and 
gave her Sulphur 20m , not to be repeated for a week ; in about 
six days she showed signs of improvement and got no other 
remedy; recovered in a few months so as to go on with her 
business, and is yet living so far as known. Many will be 
skeptical as to the correctness of our diagnosis. I was aston- 
ished at the effects of the medicine, but feel pretty confident, 
that there was not only tubercle there, but that a cavity was 
well formed.— G. N. B. 

Case 3. — C. W., set. 37, a lawyer by profession, and at the 
time of being taken down, a member of Congress; began to 
decline the second year of his stay in Washington ; of the nerv- 
ous sanguine temperament, tall and spare with light hair and 
blue eyes; had consulted several physicians before coming into 
our hands, and among them Dr. Bowditch of Boston, all of 
whom pronounced the case one of tuberculosis of the lungs; 
came into our hands the last of June, 1872. At that time suf- 
fered from a severe cough attended with very considerable ex- 
pectoration of a rather tenacious character, largely composed 
of greenish mucus with traces of pus-globules among the more 
greenish portions; much of it would almost rope; voice was 
weak and hoarse, and patient was able to sit up only one-third 
of the time ; very little appetite, and given to a great deal of 
shuddering, and so pronounced a chill as to be followed with 
considerable fever; chill came on daily and in the forenoon 
usually began on the back of the hand, or on small of the back, 
and ran up the spine; night-sweats of a sourish, unpleasant 



230 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

odor, staining under-garments. Physical signs showed apex 
of right lung to be the seat of tubercular infiltration. Several 
remedies were tried. Phosphorus in particular; taking the 
constitutional diathesis more into account than any detail of 
symptomatology, though they were of Sulphur as much as 
anything ; prescribed at last Sulphur 100 ™, and with so decided 
an effect as to have our attention called to particular sensations 
on meeting patient two days after, prefaced with the question : 
"Doctor,, what did you give me at your last visit?" We were 
also told that he was feeling better than for a long time. Did 
not repeat the dose for fourteen days, using a placebo in the 
mean time; when we did repeat the dose, it was put in among 
the same powders we were dealing out to amuse our patient with, 
numbered so he might get it first; what was our surprise to be 
promptly told on our next meeting that we had given again a 
dose of the old medicine. We asked "How do you know?" 
"By my feelings," was the reply. He was a man of the cold, 
intellectual type, believing very little in homoeopathy or any- 
thing not appealing to reason directly, in fine, the last man to 
be given to fancies. He got well in the course of the next 
twelve months; that is, he got well of his cough and recovered 
so far in his general health as to be in his seat at Washington 
the next winter, and the summer following attended to legal 
and editorial business with greater ease than for the ten years 
previous; but within eighteen months he had fistula in ano. — 
G. N. B. 

Since my leaving Vermont the gentleman has died of phthi- 
sis, some nine years after above treatment. We have numer- 
ous other cases of interest and suggestiveness, especially where 
high potencies of Sulphur have been used; we have never seen 
any good follow in this class of cases from the use of low po- 
tencies of Sulphur; in the second case mentioned above, the at- 
tending physician had used Sulphur 4th and 200th, so he said, 
and with no satisfactory results. I have myself given Sulphur 
4th and 200th with scarcely perceptible effects, and with 20 M. 
seen prompt curative action follow; even brought out the patho- 
genetic symptoms, or my patients have woefully deceived me; 
and how they could, not knowing the symptoms of the remedy, 



PHTHISIS PULMONALIS: TUBERCULAK PHTHISIS. 231 

is difficult to conceive. I confess to astonishment, but must 
believe where we can no longer doubt. That we have tried 
and failed we do not deny, but that we have succeeded at all 
is the greater wonder, and we do not expect our cases to be 
taken without grave doubts by the most of our brethren ; we 
give the cases with all the suggestiveness that follows in all 
honesty of purpose and with great hope for the future. How 
it is that our higher potencies have done for us what the lower 
failed to do, we are unable to say, and yet there is never a fact 
without a reason. Whether disease plants itself on a molecular 
basis or takes root in the vital principle, and because of this, 
demands molecular force for its dislodgement, one can answer 
as well as another. If we shall elicit investigation and further 
trial in this rather new field, we shall have done all that is 
intended by the publication of these cases. The wisest thing 
to do will be to keep watch and ward off the people and wher- 
ever opportunity allows, see to it that the inceptive stages of 
this terrible scourge be promptly dealt with, by removing the 
consumptive d} r scrasia, even from the foetus in utero if oppor- 
tunity offer; moreover we should arrest any other drift of ob- 
struction tending to the thoracic organs, knowing full well 
that the earlier an evil is dealt with the better the chances of 
success in the treatment. That we have remedies which if 
administered in season are competent to arrest a large per cent, 
of these cases, there remains no longer a doubt in our own 
mind ; it is time to begin to deal with life ad initio. 

Case 4. — "H., set. 25, when a child had crusta lactea; he- 
moptysis when 20 years old, since then constant, dry cough, dif- 
ficult breathing; after six months a second bleeding-spell, and 
again a third followed by unmistakable symptoms of phthisis. 
Symptoms: lying on his back, great emaciation and pallor, 
constant fever with aggravations in the p. m. and copious 
clammy sweats, especially on the anterior surface of the body; 
cough with tuberculous expectoration, at times consisting of 
clear pus; cough more frequent, more violent and more dry 
during the aggravations of fever; looser and with increased 
expectoration during the sweat; dull ache in different portions 
of the chest; especially and from the very beginning at a place 



232 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

between the third and fourth left ribs where physical examin- 
ation proved the existence of a large cavity; loss of appetite, 
thirst, diarrhoea, oedema of feet, sleeplessness, lassitude, indif- 
ference. Gave Sulphur 2000 , one dose; it produced early im- 
provement and after two months disappearance of all the 
symptoms; after seven months a little cough removed by Sul- 
phur; after three years still perfectly well." — Allg. Horn. Zeitg. 
XXXIX, 203, from a Spanish Journal. 

Case 5. — " M., get. 30, thickset, without hereditary tendency 
to phthisis, when a student had itch suppressed ; venereal ex- 
cesses and intemperate; has had trouble with his lungs for 
last eight years. Symptoms: pressure and tension in chest 
and epigastric region; sensation of constriction in the chest; 
to relieve this and to get breath, he is obliged to throw back 
his shoulders. Has had frequent spitting of blood; expector- 
ation at present very salty, purulent, sometimes streaked with 
blood; digestion good; blind piles; sleep uneasy, cannot go to 
sleep on account of great dry heat. Sulphur relieved him in 
a short time so that the progress of the disease was completely 
arrested ; his lungs are somewhat sensitive to cold air, but all 
during the years which have elapsed since then he has been 
able to look after his business in all sorts of weather, fair and 
foul." — Griesselich in Hygea, II, 355. 

Case 6. — " H., get. 25, when a child had itch suppressed by un- 
guents. Symptoms : Cough so violent that it terminated in chok- 
ing and vomiting, and the patient fell back utterly exhausted, his 
forehead bathed in cold sweat, with the cough, stitches in the 
chest here and there which did not, however, create difficulty 
of breathing; cough worse at night, incessant, returning as 
soon as he closed his eyes ; expectoration copious, clear pus, 
horribly fetid ; very poor appetite; extreme lassitude; drench- 
ing night-sweats, despairing mood. Gave Sulphur 30 , one dose 
each day; cough better in a short time; the night-sweats be- 
came more moderate ; gain in strength ; could go out in three 
weeks." — Kreussler in Allg. horn. Zeitg., XXIX, 154. 

Case 7. — " Man, get. 38, of delicate physique and cachectic 
appearance, in ten years has had twenty attacks of bleeding 
from the lungs; he was bled in each case and suffered after 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 233 

every paroxysm, and for weeks following from cough with 
profuse purulent expectoration. Symptoms : The bright red 
blood was expectorated in large quantities, accompanied with 
rattling in the trachea, and usually by choking and gagging, 
with painful soreness in the chest; feeling of anxiousness; 
palpitation of the heart; cold hands; oppressed breathing; in 
former years an attack of itch had been suppressed; this was 
followed by headache, later by these paroxysms of cough with 
bloody expectoration. Gave Sulphur 2 , one dose every hour; 
in the evening no more bright blood ; on the following day 
the expectoration of dark blood had also disappeared, and the 
patient could see to his business ; under the less frequent use 
of Sulphur the pus-like expectoration was removed in a few 
days." — Elwert. 

Case 8. — "L. D., set. 45, has had a cough for many months, 
attended with emaciation; the symptoms are a dull heavy 
aching on the chest, with dulness on percussion, over the lower 
right lobe, very marked, accompanied with crepitation ; chest 
feels weak; expansion of chest one inch; weight of person 134 
pounds. Prescribed Phosphorus every night for ten days, and 
gave Scott's Emulsion ; ten days later crepitus a little abated. 
Gave Sulphur 30 , one dose, and no more medicine for a month ; 
two months after commencement expansion of chest 2J inches, 
weight 135 J pounds; has taken a little cold, for which Bryo- 
nia 200 was given ; six months later all traces of condensation 
had disappeared, and had increased much in flesh." — N. C. 
Richards, M.D. 

TUBERCULINUM. 

We have no extended provings of the drug, and whether it 
differs from phosphate of lime or not, I am unable to say; it 
is composed, as we understand, of the cretacious matter which 
comes from the transformation of the caseous or albuminous 
infiltration called tubercle; it is probably a compound of phos- 
phate and carbonate of lime with soda, and possibly some 
other minerals. The remedy has been only recently intro- 
duced, and we have had no experience except in two cases 

16 



234 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

where we have attributed very decided curative effects to it, 
and if we are not mistaken it will prove a very valuable addi- 
tion to our remedies for the treatment of consumption. 

Dr. Swan reports a case with the usual features of the last 
stage of pulmonary phthisis, great emaciation, constant cough, 
purulent expectoration, profuse night-sweats, cured by Tuberculi- 
num, M. M. and C. M. M. 

Clinical. — Case 1. — Jennie J., set. 15, a blonde, unusually 
bright, and much in advance of her years intellectually, has 
led her classes at school, and made beside much proficiency in 
music, has been very nervous, easily excited for weeks, and 
often irritable, and then again moved to tears. Has been 
coughing more or less for two or three years ; had chills and 
fever a year ago, and came down in March with chills again, 
as was supposed. Chills in the afternoon with almost continuous 
fever; cough, and pains in the chest, particularly the upper left 
side; all the symptoms about the chest aggravated with the 
setting in of chills and fever; chills from 6 to 8 evening, but soon 
settled down to 7 p.m. ; fever after a little abated in the fore- 
noon and all through the night till near morning, when a sour 
sweat sets in, pulse however keeping up all the time to from 
110 to 120; walls of chest very tender, and much more so at 
about three inches below the left clavicle, where is found con- 
siderable dulness on percussion; also bronchial sounds are dis- 
tinctly heard in this region ; expectoration of a trifle of yellow- 
ish mucus, with possibly traces of purulent matter. Diagno- 
sis: cheesy condensation, with the fever attending tubercular 
infiltration, but no cavities; complicated with a malarial 
cachexia. The chills were arrested, or partly arrested at least, 
by Lycop. 200th and 10 M. Fever, however, continued, so that 
pulse only fell to 110, till Tuberculinum was given. It then 
went down to 100 per minute. The appetite, which previously 
was entirely gone, began to reappear, and visible improvement 
was seen in strength, looks, and otherwise. The preparation 
given was C. M. (Swan). 

I repeated the remedy for return of some symptoms after 
two weeks, followed by more marked improvement again ; pa- 
tient steadily improved, till cough entirely disappeared, as 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. Z3o 

well as the soreness about the lung. Menstruation, which dis- 
appeared early in her attack, was again set up after the sixth 
month, patient having gained fourteen pounds in weight. Two 
or three times she took Lycopodium for some febrile symp- 
toms with the 4 to 8 aggravation, after being put upon Tuber- 
culinum. There may properly arise a question if the case be 
not more attributable to Lycopodium than the Tuberculinum. 
We think not, from our standpoint, and we are probably best 
able to judge. The rebound which followed from the first dose 
of Tuberculinum, and which followed at subsequent periods, 
leads us to believe it was the one remedy which saved our pa- 
tient, though Lycopodium did something very creditable for 
the chill and febrile paroxysms. 

Patient almost at once began to eat and assimilate food after 
taking Tuberculinum, a thing she had not done for months. 
She showed a remarkable relish for beer and for fat boiled 
pork, the first being allowed her with malt, and the last taken 
as she liked. Cream and milk, to which was added either 
wine or brandy, was also given. 

Case 2. — Dr. Nichols writes from Boston that Calcarea pul- 
monica om , potentized by Dr. Swan, acted most favorably upon 
a cough attended by the expectoration of calcareous matter. 
The patient, a blonde female, set. 18, had lost two sisters by 
pulmonary consumption. I do not quite know if this be Dr. 
Swan's Tuberculinum. 

Case 3. — Another case presented the usual features of con- 
sumption in the last stage : " Great emaciation, constant cough, pur- 
ulent expectoration, profuse night-sweats." Tuberculinum mm + cm . 
— Dr. Swan. 

Case 4. — "A man given up to die was emaciated to the last 
degree; cough with sweet, yellow expectoration, night-sweats and 
very weak. Tuberculinum mm , Sepia mm and Phosphoric acid cm , 
helped him so much that he went to Manhatten Beach to com- 
plete his cure; got to eating finely; had no night-sweats and 
very little cough." — Dr. Swan. 

Case 5. — Dr. A., set. 26, blonde, light hair and blue eyes, of 
a scrofulous habit; began coughing a year ago; health failing, 
and cough proving obstinate; was examined by Dr. Willard, 



236 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

of Alleghany, New York, and the physician in town. Diagno- 
sis: condensation from tubercular deposit in the apex of the 
left lung; depression at the third rib; was soon taken with 
pleuritic pains followed by fever, which ran on into a hectic 
with chills, night-sweats and purulent expectoration; for 
months ran steadily down, till considered hopeless by all 
friends and her physician ; was so feeble indeed, that she could 
not be moved; sent her one dose of Tuberculinum about the 
1st of July; soon after astonishing changes followed with im- 
provement in all the lung symptoms ; fever and sweats almost 
entirely disappeared. A second dose of Tuberculinum was 
given August 12th ; improvement continued and patient was 
able to be removed to New England, where she mended a little 
and then died. — G. N. B. 

These cases are reported for the purpose of calling the atten- 
tion of the profession to the use of this remedy in phthisis. 
Some express great disgust at the mention of a nosode. 

Psorinum has had a place in our Materia Medica for a long 
time, and some of our best physicians report excellent clinical 
results from its use. 

What we want are facts in the case, and if we accept Calcarea 
phosphorata as a remedy from the mineral plane, why may 
not the cretaceous products of tubercle when potentized become 
a remedy as well? Its value is to be settled by trial. This is 
about all there is to the question. The case of Miss Young 
continued to improve, and menses appeared after a cessation 
of six months. An eruption appeared about the nose as she 
began to improve. She may be said to be fairly convalescent 
and enjoying better health than for three years at this date, 
eleven months from beginning of treatment. 

Water. — Sandozy has discovered that the hypodermic injec- 
tions of water wonderfully controls the cough of phthisical 
patients. The explanation will be found no doubt in the ner- 
vous vibrations produced. 

We often feel the need of some agent to relieve this harass- 
ing symptom, and this will not impair nutrition as would 
morphine, a remedy never to be given until the very last stage 
of the disease. 






PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 237 

"We have had no experience in the use of this agent, but 
shall try it when our simillimum fails, and such perplexity- 
arises. 

ZINCUM. 

Lungs and Thorax. — Sticking in left side of chest, with 
painfulness of left nipple. 

Spasmodic sensations in lungs and heart. Burning in chest ; cut- 
ting pains, with sense of constriction. 

Rawness and roughness are felt both in throat and chest. 

Cough. — Lasting all night; cough with shooting pains passing 
to the stomach, pains relieved after raising a little. Bloody ex- 
pectoration is frequently met with ; or spitting of blood after 
a hard coughing spell, followed by burning and soreness in chest. 
Sputa sometimes yellow, purulent, tenacious; or sweetish sputa 
with a metallic taste. 

Blood raised in the morning and during the day. 

Aggravations. — All lung symptoms worse after eating sweet 
things, partaking of wine, and after menstruation. 

Accompaniments. — Dryness in larynx. Cramp-like pain in 
external muscles of throat when swallowing. Jerking of the body 
during sleep. 

Chills begin after dinner, in open air, just before a storm, run 
down the back alternating with heat. Sweats towards morning. 

Zincum is a remedy we have used but little, but it has a 
clinical record entitling it to a place among our remedies for 
consumption. 

I regard it as best adapted to those cases where the nervous 
system shows intensity of action, possibly where anaemia exists 
and where nervous shocks, as in onanism or mental grief, are 
a cause. Provers, however, find the remedy to have very 
pointed direction toward the respiratory mucous membranes, and 
the stitches in the chest would indicate that the parenchyma 
was also affected. Purulent sputa also indicates its adapta- 
bility to the severer forms of lung degradation. 

In phthisis, where many symptoms seem to sympathize 
strongly with the female reproductive organs, with much dis- 
turbance of the sensorial and reflex system of nerves, we are 
likely to find our simillimum in Zincum. 



238 PHTHISIS PULMONALIS : TUBERCULAR PHTHISIS. 

Some affirm that phthisis itself has a primary start in the 
nervous system, and find an indication for the use of Zincum 
in this hypothesis. Such generalizations, however, can be of 
but little use practically; it has a clinical record of very high 
value in paralytic affections of the brain such as follow from 
serous exudations, and tubercle may be behind this exudation. 
It is well to remember this fact, as it may point to a force in 
the drug capable of modifying the tubercular dyscrasia. 



FAVORABLE SYMPTOMS FOLLOWING THE ACTION 

OF A REMEDY, ACCORDING TO NIESSER'S 

OBSERVATIONS. 

1. Swelling of the glands in the axilla. 

2. Rheumatism in the muscles of the neck, shoulders, thorax, 
hips or extremities. 

3. Swelling of the glands of the neck and ear. 

4. The materia peccaus rises from within toward the outside, 
contrary to the air which passes during respiration from with- 
out inward. The chest feels lighter, but the trachea and lar- 
ynx become affected in a manner to produce hoarseness, 
which subsiding, the nose becomes sore, and finally ends with 
pimples and pustules around the nose. This soreness, followed 
by pimples and pustules, was especially noticeable in the case 
of Miss Young, reported cured by Tuberculinum and Lycopo- 
dium. 

5. The ears become affected, from mere ringing in the ears 
to suppuration within them. 

6. The eyes become inflamed. 

7. Headache and toothache set in ; in such cases let the pa- 
tient suffer; a sudden suppression of them would quickly bring 
back all the troubles in the chest. 

8. Eruptions on the thorax with or without itching in the 
chest or back. 

9. Sweating of the feet. 

10. Hemorrhoidal irritations and tumors. 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 239 

11. Violent colds in the head, which indicate Aeon, or Phos- 
phor., and which almost always act beneficially. 

12. The morbid action goes down into the intestines, and 
throws out' gall and acid, mucus, or gas, until finally it de- 
velopes itself in a cutaneous disease, first attacking the head, 
the upper extremities, the thorax, and so on down like 
small-pox. 

When a well-selected remedy brings forth any of these 
symptoms, never disturb its action by change or repetition. 

In the case of Mr. Willard, fistula in ano, followed the im- 
provement of the lungs from Sulphur 100 " 1 . 

In the case of one lady the invasion of the lung followed 
from the cessation of activity in a lupus upon the face which 
had first appeared in the eyelid upon opposite side, metastasis 
following from the use of Kali carb., low. Another from the 
discussion of a glandular tumor by Iodine. 



MODE OF ADMINISTERING REMEDIES. 

We have come to the conclusion, after careful observation, 
that it is not well to repeat a remedy more frequently than two 
or three times a week, and perhaps not as frequently even as 
that; in our best cures the remedy was only repeated three or 
four times in two or three months ; in one case only one dose 
was given, no improvement showing for the first six days, but 
thereafter it was continuous to a recovery; it was where a 
small cavity had opened up about two inches below the clavi- 
cle, on the left side; the remedy was Sulphur and the 20 M., 
Fincke. In a very grave case cured by Silesia, patient got 
about two doses of the 200th a week for six weeks or so. In a 
case cured by Stannum, patient got four doses in all of the 3d 
centesimal trituration. In one case where Sulphur was given 
in the third dilution at night and repeated in the morning, so 
excessive was the aggravation that patient died in four days 
from excessive accumulation of fluids in the bronchioles. We 
are satisfied that both Phosphorus and Sulphur are liable to 



240 PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 

dangerous aggravations, and do not know any other remedy 
that may not have its dangers when administered to patients 
in the tuberculous state, either too frequently or in too crude a 
form. We are glad to be able to add other testimony, and 
quote from the Counsellor, Dr. D'Espiney, of Nizza, France, 
who says : " Of fifteen years practice, and since I began to use 
dynamized drugs I have seen many cases of phthisis singu- 
larly ameliorated or cured under homoeopathic treatment, and 
my confidence is established. But I found out a while since 
that my patients succumbed more rapidly than formerly, and 
I became convinced that in certain forms or periods of phthi- 
sis the inconsiderate employment of homoeopathic drugs may 
sensibly accelerate the fatal issue." Dr. Charge' is of the same 
opinion; he, being asked one day about the use of Phosphorus, 
and especially its repetition, replied, that he put the same 
question to Rummell, who replied: "Phosphorus always suc- 
ceeds with me when I know how to give it." "And what do 
you mean by knowing how to give it?" "A dose every fifteen 
days." Charge' adds : " Rummell is right. In certain cases of 
phthisis some drugs, and especially Phosphorus, may produce 
the most horrible ravages when we repeat the doses too close ' 
together." He then adds: "About fifteen years ago I was 
accidentally in a city where I was requested to visit a nun 
suffering from a slight tuberculous infiltration in one apex of 
her lungs ; her general health was still good ; she only com- 
plaiaaed of a little dry cough, and the expectoration contained 
sometimes streaks of blood ; she was a blonde, small and ten- 
der, with blue eyes, white teeth, and fine complexion ; she re- 
ceived three powders, each containing ten or twelve globules 
of Phosphorus, with the advice to dissolve a powder in nine 
spoonfuls of water, take three times a day a spoonful for three 
days, and then omit three days, and thus continue till finished. 
I returned to the city in about forty days, and was horror- 
stricken when she appeared. The pulmonary lesion had fear- 
fully progressed, whereas formerly it was very slow. I was 
told that after taking a few doses a serious hemorrhage set in. 
The medicine was continued till a more serious bleeding fol- 
lowed." The more serious and dangerous our case the more 



PHTHISIS PULMONALIS: TUBERCULAR PHTHISIS. 241 

caution are we to take in the administration of our remedies. 
The more danger from repetition and low dilutions. 

The author in giving his experiences upon dilutions and in 
quoting the experiences of others has no other object in view 
than that of reaching the exact truth upon the matter under 
discussion. As a controversialist we join no party but claim 
the right to use any and all dilutions ; and yet our experience 
we feel bound to give as well as the logical inferences follow- 
ing the same. In all clinical cases reported we have given the 
dilution or potency when given us. If cures have followed 
the use of the cruder preparations, to any extent, they have not 
been given us, and we have honestly sought for information in 
all quarters, sending special invitations through our journals 
and by letter. My own case cured by Stannum is perhaps the 
best case cured by the lower triturations or dilutions we have. 

We certainly fear that disappointment will come to him who 
shall from any motive discard the higher attenuations. The ten- 
dency of modern science is to the acceptance of the theory of 
molecular energy being at the bottom of all transformations 
and vital movements. If there be anything clear in the his- 
tory of recent investigations in the domain of physics, it is 
that Hahnemann was a century in advance of his colleagues 
as a thinker and observer. If neural analysis shall show that 
his 30th potency actually impresses more rapidly and more 
profoundly the nervous system than the 2d, it will certainly 
increase our respect for a man whose consummate abilities en- 
title him to the first place among physicians. 



INDEX. 



Aconite, 89 
Acute phthisis, 151 
Alcoholism, 29, 
Alumina, 78 to 107 
Antimonium crud., 108 
Apium vir., 78 to 152 
Arnica, 90 
Arsenicum, 156, 160 
Arsenicum iod., 109 
Auscultation of chest, 54 
Auscultation of voice, 63 

Baths, 148 
Baptisia tinct., 160 
Belladonna, 90 
Bromium, 110, 137 
Bryonia, 130 

Cactus grand., 91 

Calcarea carb., 79, 110 to 113, 161 to 170 

Calcarea phos., 171 

Carbo veg., 102, 113, 175 

Catarrhal phthisis, 103 

Causticum, 106, 177 

Causes of phthisis, 12 

Cinchona off., 92 

Climate, 145 

Clinical, Alumina, 107 

Antimonium, 109 

" Apium, 155 

" Arsenicum, 158 to 160 

" Ars. iod., 109 

" Bryonia, 130 

" Calc. carb., 112, 162 to 170 

" Carbo veg., 114, 175 

" Causticum, 177 

" Ferrum iod., 185 

" Iodine, 188 

" Kali bichr., 189 

" Kali carb., 114, 191 

" Kali hydr., 115, 192 

" Kali mur, 193 

" Lachesis, 194 to 196 



Clinical, Lycopodium, 82, 96, 116, 128, 
198 to 200 

" Magnesia mur., 105 

" Mercurius cor., 117 

" Mercurius proto. iod., 119 

" Mercurius viv., 131, 203 

" Myrtus com., 204 

" Nitric acid, 120 

" Petroleum, 175 

" Phosphorus, 127 to 129, 208 

" Plumbum acet., 99 

" Pulsatilla, 84 

" Psorinum, 210 

" Sambucus, 212 

" Sanguinaria can., 213 

" Sepia, 84, 101 

" Silicea, 216 

" Silphium, 219 

" Stannum, 221 

Sulphur, 227 to 233 

" Tuberculinum, 234 to 236 
Conium mac, 79, 114, 180 
Contagiousness of phthisis, 27 
Contractions of chest, significance of, 44 

Digitalis, 94 

Disintegration of lung tissue, 36 
Drainage, surgical, 149 
Dulcamara, 182 

Early recognition of phthisis, import- 
ance of, 86 
Elaps cor., 93 
Eupatorium per., 182 
Exciting causes,. 16 

Ferrum,_80, 93, 183 
Ferrum iod.. 185 
Food, 146 

Frequency of phthisis, 73 
Function of the lungs, 11 



Hamamelis, 93 



(243) 



244 



INDEX. 



Hemoptysis, 17, 86 
Hemoptysis, treatment of, 88 
Hepar, 186 

Incipient phthisis apt to be overlooked, 

11 
Iodine, 81, 87 
Ipecacuanha, 94 

Kali bichr., 189 
Kali carb., 114, 191 
Kali hydr., 114, 192 
Kali mur, 193 
Kreosotum, 194 

Lachesis, 193 

Ledum, 96 

Leukaemia, 18 

Lycopodium, 82, 96, 116, 128, 197 

Magnesia mur., 105 

Mercurius cor., 117, 131 

Mercurius proto. iod., 118 

Mercurius viv., 131 

Mode of administering remedies, 239 

Murex purp., 83 

Myrtus com., 204 

Natrum mur., 205 
Nitric ac, 119, 205 
Niesser's observations, 238 

Percussion, thoracic, 49 
Petroleum, 175 
Phosphorus, 97, 126, 206 
Phosphoric ac, 98 
Pneumonia, 123 

fibrous, 124 

" interstitial, 137 

clinical cases reported, 126 
to 131 
Psorinum, 209 
Phthisis, acute, 151 

" chronic, 152 

" a lymphangitis, 23 

" bovine, 32 

" intestinal complications, 137 



Phthisis, pharyngeal, 133 

" laryngeal, 134 

" syphilitic, 75 
Physical diagnosis, 41 
Plumbum acet., 99 
Prodromic symptoms, 68 
Prolonged respiration, 43 
Pulsatilla, 83 

Rales, 57 
Regimen, 139 
Rhus tox., 99 

Sambucus nig., 211 

Sanguinaria can., 100, 213 

Secale cor., 100 

Sepia, 84, 101 

Silicea, 216 

Silphium, 218 

Spongia, 222 

Sputa, 64 

Stannum, 101, 221 

Sticta, 222 

Suggestions for the early management 

of phthisis, 70 
Sulphur, 127, 228 
Swan's, Dr., postulate, 34 

Theoretical opinions upon tubercle, 20 
Thoracic measurements, 47 

" percussion, 49 
Treatment of phthisis, errors in, 154 

pneumatic, 150 
Tubercular degradation but a fragment 

of a constitutional malady. 9 
Tubercular transformations, 32 
Tuberculinum, 233 
Typical chest, 44 

Uterine troubles may lead to consump- 
tion, 76 

Vitality a correlating force, 10 

Water, 236 

Who are immure, 29 

Zincum met., 237 






BOERICKE & TAFEL'S 

^HonwBopathic Publications.^ 



ALLEN, DR. T. F. The Encyclopedia of Pure Materia Medica; 
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HOMOEOPATHIC PUBLICATIONS. 



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HAHNEMANN, DR. S. The Lesser Writings of. Collected and 
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HAHNEMANN, DR. S. Organon of the Art of Healing. By 

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therapeutics,' instead of the ' characteristics ' of the third edition." — British Journal of 

HOMOEOPATHY. 

HALE, DR. E. M. The Medical, Surgical, and Hygienic Treat- 
ment of Diseases of Women, especially those causing Ster- 
ility, the Disorders and Accidents of Pregnancy, and Pain- 
ful and Difficult Labor. By Edwin M. Hale, M.D., Professor of 
Materia Medica and Therapeutics in the Chicago Homceopathic College, 
etc., etc. Second enlarged edition. 378 pages. 8vo. Cloth, $2 50 

'■ This new work embodies the observations and experience of the author during twenty- 
five years of active and extensive practice, and is designed to supplement rather than super- 
cede kindred works. The arrangement of the subjects treated is methodical and convenient; 
the introduction containing an article inserted by permission of Dr. Jackson, of Chicago, the 
author upon the ovular and ovulation theory of menstruation, which contains all the obser- 
vations of practical importance known on this subject to date. The diseases causing sterility 
are fully described, and the medical, surgical and hygienic treatment pointed out. The 
more generally employed medicines are enumerated, but their special or specific indications 
are unfortunately omitted. The general practitioner will find a great many valuable things 
for his daily rounds, and cannot afford to do without the book. The great reputation and 
ability of the author are sufficient to recommend the work, and to guarantee an appreciative 
reception and large sale." — Hahnemannian Monthly. 

HART, DR. C. P. Diseases of the Nervous System. Being a 
Treatise on Spasmodic, Paralytic, Neuralgic and Mental Affections. 
For the use of Students and Practitioners of Medicine. By Chas. Por- 
ter Hart, M.D , Honorary Member of the College of Physicians and 
Surgeons of Michigan, etc., etc., etc. Pp. 409. 8vo. Cloth, $3 00 

" This work supplies a need keenly felt in our school — a work which will be useful 
alike to the general practitioner and specialist; containing, as it does, not only a condensed 
compilation of the views of the best authorities on the subject treated, but also the author's 
own clinical experience ; to which is appended the appropriate homoeopathic treatment of 
each disease. It is written in an easy, flowing style, at the same time there is no waste of 
words. ***** We consider the work a highly valuable one, bearing the evidence 
of hard work, considerable research and experience." — Medico-Chirurgical Quarterly. 

" We feel proud that in Hart's ' Diseases of the Nervous System ' we have a work up to 
date, a work which we need not feel ashamed to put in the hands of the neurologist or 
alienist for critical examination, a work for which we predict a rapid sale." — North Amer- 
ican Journal of Homceopathy. 

HELMUTH, DR. W. T. A System of Surgery. Illustrated with 
568 Engravings on Wood. By Wm. Tod Helmuth, M.D. Fourth edi- 
tion. 1000 pages. Sheep, . . . . . . . $8 50 

This edition of Dr. Helmuth's great work is already in appearance a great improve- 
ment over the old edition, it being well printed on fine paper, and well bound. By in- 
creasing the size of the page, decreasing the size of type, and setting up solid, fully one-half 
more printed matter is given than in the previous edition, albeit there are over 200 pages 



HOMOEOPATHIC PUBLICATIONS. 



less; and while the old edition, bound in sheep, was sold at $11.50 by its publishers, this 
improved third edition is now furnished at $3 less, or for $8.50. The author brought the 
work fully up to date, and for an enumeration of some of the more important improvements, 
we cannot do better than to refer to Dr. Helmuth's own Preface. 

HEMPEL, DR. C. J., and DR. J. BEAKLEY. Homoeopathic 
Theory and Practice. With the Homoeopathic Treatment of Surgi- 
cal Diseases, designed for Students and Practitioners of Medicine, and 
as a Guide for an intelligent public generally. Fourth edition. 1100 
pages, . ■ • 13 00 

HERING, DR. C. Condensed Materia Medica. Second edition. 
More condensed, revised, enlarged, and improved, . . $7 00 

In February, 1877, we were able to announce the completion of Hering's Condensed 
Materia Medica. The work, as was to be expected, was bought up with avidity by the pro- 
fession and already in the fall of 1878 the author set to work perfecting a second and im- 
proved edition. By still more condensing many of the remedies, a number of new ones 
could be added without much increasing the size and the price of the work. This new 
edition is now ready for the profession, and will be the standard work par excellence for the 
practitioner's daily reference. 

HEINIGKE, DR. CARL. Pathogenetic Outlines of Homoeo- 
pathic Drugs. Translated from the German by Emil Tietze, M.D., 
of Philadelphia. 576 pages. 8vo. Cloth, . . . $3 50 

This work, but shortly issued, is already meeting with a large sale and an appreciative 
reception. It differs from most works of its class in these respects : 

1. That the symptomatic outlines of the various drugs are based exclusively upon the 
' pathogenetic" results of provings. 

2. That the anatomico-physiological arrangement of the symptoms renders easier the 
understanding and survey of the provings. 

3. That the pathogenetic pictures drawn of most of the drugs, gives the reader a clearer 
idea and a more exact impression of the action of the various remedies. 

Each remedy is introduced with a brief account of its preparation, duration of action 
and antidotes. 

HOLCOMBE, DR. W. H. Yellow Fever and its Homoeopathic 
Treatment, 10 cts. 

HOLCOMBE, DR. W. H. What is Homoeopathy? A new ex- 
position of a great truth. 28 pages. 8vo. Paper cover. Per dozen, 

#1-25, 15 cts. 

" Prove all things, hold fast that which is good." — St. Paul. 

HOLCOMBE, DR. W. H. How I became a Homoeopath. 28 

pages. 8vo. Paper cover. Per dozen, $1.25, . . . 15 cts. 

HOLCOMBE, DR. W. H. Special Report of the Homoeopathic 
Yellow Fever Commission, ordered by the American Institute of 
Homoeopathy for presentation to Congress. 32 pages. 8vo. Paper. 
Per hundred, $4.00, ........ 5 cts. 

This Report, written in Dr. Holcombe's masterly manner, is one of the best campaign 
documents for homoeopathy. The statistics must convince the most skeptical, and every 
homceopathic practitioner should feel in duty bound to aid in securing its widest possible 
circulation. 

HOMOEOPATHIC POULTRY PHYSICIAN (Poultry Veteri- 
narian) ; or, Plain Directions for the Homoeopathic Treatment of the 



BOERICKE & TAFEL'S 



most Common Ailments of Fowls, Ducks, Geese, Turkeys and Pigeons, 
based on the author's large experience, and compiled from the most re- 
liable sources, by Dr. Fr. Schroter. Translated from the German. 84 
pages. i2mo. Cloth,. . . . . . . -50 cts. 

We imported hundreds of copies of this work in the original German for our customers, 
and as it gave good satisfaction, we thought it advisable to give it an English dress, so as to 
make it available to the public generally. The little work sells very fast, and our readers 
will doubtless often have an opportunity to draw the attention of their patrons to it. 

HOMOEOPATHIC COOKERY. Second edition. With Additions 
by the Lady of an American Homoeopathic Physician. Designed chiefly 
for the Use of such Persons as are under Homoeopathic Treatment. 1 76 
pages, 50 cts. 

HULL'S JAHR. A New Manual of Homoeopathic Practice. 

Edited, with Annotations and Additions, by F. G. Snelling, M.D. 

Sixth American edition. With an Appendix of the New Remedies, by 

C. J. Hempel, M.D. 2 volumes. 2076 pages, . . $9 00 

The first volume, containing the symptomatology, gives the complete pathogenesis of 
two hundred and eighty-seven remedies, besides, a large number of new remedies are added 
by Dr. Hempel, in the appendix. The second volume contains an admirably arranged Re- 
pertory. Each chapter is accompanied by copious clinical remarks and the concomitant 
symptoms of the chief remedies for the malady treated of, thus imparting a mass of informa- 
tion, rendering the work indispensable to every student and practitioner of medicine. 

JAHR, DR. G. H. G. Therapeutic Guide ; the most Important Re- 
sults of more than Forty Years' Practice. With Personal Observations 
regarding the truly reliable and practically verified Curative Indications 
in actual cases of disease. Translated, with Notes and New Remedies, 
by C. J. Hempel, M.D. 546 pages, . . . . . I3 00 

" With this characteristically long title, the veteran and indefatigable Jahr gives us 
another volume of homoeopathies. Besides the explanation of its purport contained in the 
title itself, the author's preface still further sets forth its distinctive aim. It is intended, he 
says, as a ' guide to beginners, where I only indicate the most important and decisive points 
for the selection of a remedy, and where I do not offer anything but what my own individual 
experience, during a practice of forty years, has enabled me to verify as absolutely decisive 
in choosing the proper remedy. The reader will easily comprehend that, in carrying out 
this plan, I had rigidly to exclude all casts concerning which I had no experience of my 

own to offer We are bound to say that the book itself is agreeable, chatty, and 

full of practical observation. It may be read straight through with interest, and referred to 
in the treatment of particular cases with advantage." — British Journal of Homoeopathy. 

JAHR, DR. G. H. G. The Homoeopathic Treatment of Dis- 
eases of Females and Infants at the Breast. Translated from 
the French by C. J. Hempel, M.D. 422 pages. Half leather, $2 00 

This work deserves the most careful attention on the part of homoeopathic practitioners. 
The diseases to which the female organism is subject are described with the most minute 
correctness and the treatment is likewise indicated with a care that would seem to defy 
criticism. No one can fail to study this work but with profit and pleasure. 

INDEX to the first eighteen volumes of the North American Journal of 
Homoeopathy. Paper, . . . . . . . . $2 00 

JONES, DR. SAMUEL A. The Grounds of Homoeopathic 
Faith. Three Lectures, delivered at the request of Matriculates of the 
Department of Medicine and Surgery (Old School) of the University of 



HOMOEOPATHIC PUBLICATIONS. 



Michigan. By Samuel A. Jones, M.D., Professor of Materia Medica, 

Therapeutics, and Experimental Pathogenesy in the Homoeopathic 

Medical College of the University of Michigan, etc., etc. 92 pages. 

i2mo. Cloth. Per dozen, $3.00; per hundred, $20.00, . 30 cts. 

Lecture first is on The Law of Similars; its Claim to be a Science in that it 
Enables Perversion. Lecture second, The Single Remedy a Necessity of Science. 
Lecture third, The Minimum Dose an Inevitable Sequence. A fourth Lecture, on The 
Dynamization Theory, was to have finished the course, but was prevented by the approach 
of final examinations, the preparation for which left no time lor hearing evening lectures. 
The Lectures are issued in a convenient size for the coat-pocket; and as an earnest testi- 
mony to the truth, we believe they will find their way into many a homoeopathic household. 

JOHNSON, DR. I. D. Therapeutic Key; or, Practical Guide for 
the Homoeopathic Treatment of Acute Diseases. Tenth edition. 347 
pages. Bound in linen, . . . . . . . $1 75 

Bound in flexible cover, . . . . . . . $2 25 

This has been one of the best selling works on our shelves; more copies being in circu- 
lation of this than of any two other professional works put together. It is safe to say that 
there are but few homoeopathic practitioners in this country but have one or more copies of 
this little remembrancer in their possession. 

JOHNSON, DR. I. D. A Guide to Homoeopathic Practice. De- 
signed for the use of Families and Private Individuals. 494 pages. 
Cloth, . . . . . . . . . . . $2 00 

This is the latest work on Domestic Practice issued, and the well and favorably known 
author has surpassed himself. In his book fifty-six remedies are introduced for internal ap- 
plication, and four for external use. The work consists of two parts. Part I is subdivided 
into seventeen chapters, each being devoted to a special part of the body, or to a peculiar 
class of disease. Part II contains a short and concise Materia Medica, i. e.. gives the 
symptoms peculiar to each remedy. The whole is carefully written with a view of avoiding 
technical terms as much as possible, thus insuring its comprehension by any person of ordi- 
nary intelligence. A complete set of remedies in vials holding over fifty doses each, is fur- 
nished for $7. or in vials holding over one hundred doses each for $10, or book and case 
complete for $9 or $12 respectively. Address orders to Boericke & Tafel's Pharmacies at 
New York, Philadelphia, Baltimore, Chicago, New Orleans, or San Francisco. 

JOSLIN, DR. B. F. Principles of Homoeopathy. In a Series of 
Lectures. 185 pages. i2mo. Cloth, . . . .60 cts. 

KREUSSLER, DR. E. The Homoeopathic Treatment of Acute 
and Chronic Diseases. Translated from the German, with Im- 
portant Additions and Revisions, by C. J. Hempel, M.D. 190 
pages, . 60 cts. 

The author is a practitioner of great experience and acknowledged talent. This work 
is distinguished by concise brevity and lucid simplicity in the description of the various 
diseases that usually come under the observation of physicians, and the remedies for the 
various symptoms are carefully indicated. Dr. Hempel has interspersed it with a number 
of highly useful and interesting notes, which cannot fail to enhance the value of this work 
to American physicians. 

LAURIE and McCLATCHEY. The Homoeopathic Domestic 
Medicine. By Joseph Laurie, M.D. Ninth American, from the 
Twenty-first English edition. Edited and Revised, with Numerous and 
Important Additions, and the Introduction of the New Remedies. By 
R. J. McClatchey, M.D. 1044 pages. 8vo. Half morocco, $5 00 
"We do not hesitate to indorse the claims made by the publishers, that this is the most 

complete, clear, and comprehensive treatise on the domestic homoeopathic treatment of dis- 



10 BOERICKE & TAFEL'S 



eases extant. This handsome volume of nearly eleven hundred pages is divided into six 
parts. Part one is introductory, and is almost faultless. It gives the most .complete and 
exact directions for the maintenance of health, and of the method' of investigating the con- 
dition of the sick, and of discriminating between different diseases. It is written in the 
most lucid style and is above all things wonderfully free from technicalities. Part two 
treats of symptoms character, distinctions, and treatment of general diseases, together with 
a chapter on casualties. Part three takes up diseases peculiar to women. Part four 
is devoted to the disorders of infancy and childhood. Part five gives the characteristic 
symptoms of the medicines referred to in the body of the work, while Part six introduces 
the repertory."- — Hahnemannian Monthly. 

' Of the usefulness of this work in cases where no educated homoeopathic physician is 
within reach, there can be no question. There is no doubt that domestic homoeopathy has 
done much to make the science known ; it has also saved lives in emergencies. The prac- 
tice has never been so well presented to the public as in this excellent volume." — New 
Eng. Med. Gazette. 

A complete set of remedies of one hundred and four vials, containing over fifty doses 
each, is furnished for $12. put up in an elegant mahogany case. A similar set in vials con- 
taining over one hundred doses each, is furnished for $x8 or book and case complete for 
$17 or $23 respectively. Address orders to Boericke & Tafel's Pharmacies at New York, 
Philadelphia, Baltimore, Chicago, New Orleans', or San Francisco. 

LILIENTHAL, DR. S. Homoeopathic Therapeutics. By S. 

Lilienthal, M.D., Editor of North American Journal of Homoeo- 
pathy, Professor of Clinical Medicine and Psychology in the New York 
Homoeopathic Medical College, and Professor of Theory and Practice 
in the New York College Hospital for Women, etc. Second edition. 

8vo, |5°° 

Half morocco, . . . . . . . . . |6 00 

" Certainly no one in our ranks is so well qualified for this work as he who has done it, 
and in considering the work done, we must have a true conception of the proper sphere of 
such a work. For the fresh graduate, this book will be invaluable, and to all such we un- 
hesitatingly and very earnestly commend it. To the older one, who says he has no use for 
this book, we have nothing to say. He is a good one to avoid when well, and to dread 
when ill. We also hope that he is severely an unicum." — Prof. Sam. A. Jones in Ameri- 
can HOMOiOPATHIST. 

" . . . It is an extraordinary useful book, and those who add it to their library 
will never feel regret, for we are not saying too much in pronouncing it the BEST WORK ON 
therapeutics in homoeopathic (or any other) literature. With this under one elbow, and 
Hering's or Allen's Materia Meoica under the other, the careful homoeopathic practitioner 
can refute Niemayer's too confident assertion, ' I declare it idle to hope for a time when a 
medical prescription should be the simple resultant of known quantities.' Doctor, by all 
means buy Lilienthal's Homosopathic Therapeutics. It contains a mine of wealth." — 
Prof. Chas. Gatchel in Ibid. 

LUTZE, DR. A. Manual of Homoeopathic Theory and Prac- 
tice. Designed for the use of Physicians and Families. 
Translated from the German, with additions by C. J. Hempel, M.D. 
From the sixtieth thousand of the German edition. 750 pages. 8vo. 
Half leather, . $2 50 

This work, from the pen of the late Dr. Lutze, has the largest circulation of any homoeo- 
pathic work in Germany, no less than sixty thousand copies having been sold. The intro- 
duction, occupying over fifty pages, contains the question of dose, and rules for examining 
the patient, and diet; the next sixty pages contain a condensed pathogenesis of the remedies 
treated of in the work; the description and treatment of diseases occupy four hundred and 
eighteen pages, and the whole concludes with one hundred and seventy-three pages of reper- 
tory and a copious index, thus forming a concise and complete work on theory and practice. 

MALAN, H. Family Guide to the Administration of Homoeo- 
pathic Remedies. 112 pages. 321110. Cloth, . . 30 cts. 



HOMOEOPATHIC PUBLICATIONS. 11 

MANUAL OF HOMOEOPATHIC VETERINARY PRAC- 
TICE. Designed for all kinds of Domestic Animals and Fowls, pre- 
scribing their proper treatment when injured or diseased, and their par- 
ticular care and general management in health. Second and enlarged 
edition. 684 pages. 8vo. Half morocco, . . . I5 00 

" In order to rightly estimate the value and comprehensiveness of this great work, the 
reader should compare it, as we have done, with the best of those already before the public. 
In size, fulness and practical value it is head and shoulders above the very best of them, 
while in many most important disorders it is far superior to them altogether, containing, as 
it does, recent forms of disease of which they make no mention." — Hahnemannian 
Monthly. 

MARSDEN, DR. J. H. Handbook of Practical Midwifery, with 
full instructions for the Homoeopathic Treatment of the 
Diseases of Pregnancy, and the Accidents and Diseases in- 
cident to Labor and the Puerperal State. By J. H. Maroden, 
A.M.,M.D. 315 pages. Cloth, $2 25 

" It is seldom we have perused a text-book with such entire satisfaction as this. The 
author has certainly succeeded in his design of furnishing the student and young practitioner, 
within as narrow limits as possible, all necessary instruction in practical midwifery. The 
work shows on every page extended research and thorough practical knowledge. The style 
is clear, the array of facts unique, and the deductions judicious and practical. We are par- 
ticularly pleased with his discussion on the management of labor, and the management of 
mother and child immediately after the birth, but much is left open to the common-sense 
and practical judgment of the attendant in peculiar and individual cases." — Homceopathic 
Times. 

MOHR, DR. CHARLES. The Incompatible Remedies of the 
Homoeopathic Materia Medica. By Charles Mohr, M.D., Lec- 
turer on Homoeopathic Pharmaceutics, Hahnemann Medical College, 
Philadelphia. (A paper read before the Homoeopathic Medical Society 
of the County of Philadelphia.) Pamphlet, in cover, . . 10 cts. 

This is an interesting paper, which will well repay perusal and study. It gives a list of 
fifty-seven remedies and their incompatibles, diligently collated from the best-known sources. 

MORGAN, DR. W. The Text-book for Domestic Practice, 

being plain and concise directions for the Administration of Homceo- 
pathic Medicines in Simple Ailments. 191 pages. 321T10. Cloth, 50 cts. 

This is a concise and short treatise on the most common ailments, printed in convenient 
size for the pocket; a veritable traveller's companion. 

A complete set of thirty remedies, in vials holding over fifty doses each, is furnished for 
$4.50, in stout mahogany case; or same set in vials holding over one hundred doses each, 
for $6.50; or book and case complete for $5 or $7 respectively. Address orders to Boericke 
& Tafel's Pharmacies, New York, Philadelphia, Baltimore, Chicago, New Orleans, or San 
Francisco. 

MURE, DR. B. Materia Medica; or, Provings of the Principal Ani- 
mal and Vegetable Poisons of the Brazilian Empire, and their Applica- 
tion in the Treatment of Diseases. Translated from the French, and 
arranged according to Hahnemann's Method, by C. J. Hempel, M.D. 
220 pages. i2mo. Cloth, . . . . . . . $1 00 

This volume, from the pen of the celebrated Dr. Mure, of Rio Janeiro contains the 
pathogenesis of thirty-two remedies, a number of which have been used in general practice 
ever since the appearance of the work. A faithful wood-cut of the plant or animal treated 
of accompanies each pathogenesis. 



12 BOERICKE & TAFEL'S 



NEIDHARD, DR. C. On the Universality of the Homoeopathic 
Law of Cure, . . . 30 cts. 

NEW PROVINGS of Cistus Canadensis, Cobaltum, Zingiber and Mer- 
curius Proto-Iodatus. 96 pages. Paper, . . . 75 cts. 

NORTH AMERICAN JOURNAL OF HOMOEOPATHY. Pub- 
lished quarterly on the first days of August, November, February and 
May. Edited by S. Lilienthal, M.D. Vol. X, New Series, com- 
menced in August, 1879. Subscription price per volume, in advance, 

$4 OG 

Complete sets of the first twenty-seven volumes, in half morocco bind- 
ing, including Index to the first eighteen volumes, . . $90 00 
Index to the first eighteen volumes, . . . . $2 00 

OEHME, DR. F. G. Therapeutics of Diphtheritis. A Compila- 
tion and Critical Review of the German and American Homoeopathic 
Literature. Second enlarged edition. 84 pages. Cloth, . 60 cts. 

" This pamphlet contains the best compilation of reliable testimony relative to diph- 
theria that has appeared from the pen of any member of our school." — Ohio Medical and 
Surgical Reporter. 

" Although he claims nothing more for his book than that it is a compilation, with 
' critical reviews,' he has done his work so well and thoroughly as to merit all praise." — 
Hahnemannian Monthly. 

"Dr. Oehme's little book will be worth many times its price to anyone who has to treat 
this terrible disease." — British Journal of Homoeopathy. 

"It is the best monograph we have yet seen on diphtheria." — Cincinnati Medical 
Advance. 

PETERS, DR. J. C. A Complete Treatise on Headaches and 
Diseases of the Head. I. The Nature and Treatment of Head- 
aches. II. The Nature and Treatment of Apoplexy. III. The Nature 
and Treatment of Mental Derangement. IV. The Nature and Treat- 
ment of Irritation, Congestion, and Inflammation of the Brain and 
its Membranes. Based on Th. J. Riickert' v s Clinical Experiences in 
Homoeopathy. 586 pages. Half leather, . . . . $2 50 

PETERS, DR. J. C. A Treatise on Apoplexy. With an Appendix 
on Softening of the Brain and Paralysis. Based on Th. J. Ruckert's 
Clinical Experiences in Homoeopathy. 164 pages. 8vo. Cloth, $1.00 

PETERS, DR. J. C. The Diseases of Females and Married 
Females. Second edition. Two parts in one volume. 356 pages. 
Cloth, $1 50 

PETERS, DR. J. C. A Treatise on the Principal Diseases of 
the Eyes. Based on Th. J. Ruckert's Clinical Experiences in Ho- 
moeopathy. 291 pages. 8vo. Cloth, . . . . . |i 50 

PETERS, DR. J. C. A Treatise on the Inflammatory and Or- 
ganic Diseases of the Brain. Based on Th. J. Ruckert's Clinical 
Experiences in Homoeopathy. 156 pages. 8vo. Cloth, . $1 00 



HOMCEOPATHIC PUBLICATIONS. 13 

PETERS, DR. J. C. A Treatise on Nervous Derangement and 
Mental Disorders. Based on Th. J. Riickert's Clinical Experiences 
in Homoeopathy. 104 pages. 8vo. Cloth, . . $1 00 

PHYSICIAN'S VISITING LIST AND POCKET REPER- 
TORY, THE HOMCEOPATHIC. By Robert Faulkner, M.D. 
Second edition, . . , . . . . . , |2 00 

" Dr. Faulkner's Visiting List is well adapted to render the details of daily work more 
perfectly recorded than any book prepared for the same purpose with which we have hitherto 
met. It commences with Almanacs for 1877 and 1878; then follow an obstetric calendar; 
a list of Poisons and their Antidotes; an account of Marshall Hall's ready method in As- 
phyxia ; a Repertory of between sixty and seventy pages ; pages marked for general memo- 
randa; Vaccination Records; Record of Deaths; Nurses; Friends and others; Obstetric 
Record, which is especially complete; and finally, pages ruled to keep notes of daily visits, 
and also spaces marked for name of the medicine ordered on each day. The plan devised 
is so simple, so efficient, and so clear, that we illustrate it on a scale just half the size of the 
original (here follows illustration). The list is not divided into special months, but its use 
may be as easily commenced in the middle of the year as at the beginning. We heartily 
recommend Faulkner's List to our colleagues who may be now making preparations for the 
duties of 1878." — Monthly Homoeopathic Review, London. 

RAUE, DR. C. G. Special Pathology and Diagnosis, with 

Therapeutic Hints. 1072 pages. 8vo. Half morocco. Second 

edition, ... . . . . . . . . $7 00 

This standard work is used as a textbook in all our colleges, and is found in almost every 
physician's library. An especially commendable feature is that it contains the application 
of nearly all the new remedies contained in Dr. Hale's work on Materia Medica. 

REIL, DR. A. ACONITE, Monograph on, its Therapeutic and 

Physiological Effects, together with its Uses and Accurate 

Statements, derived from the various Sources of Medical 

Literature. By A. Reil, M.D. Translated from the German by 

H. B. Millard, M.D. Prize essay. 168 pages, . . .68 cts. 

"This Monograph, probably the best which has ever been published upon the subject, 
has been translated and given to the public in English, by Dr. Millard, of New York. 
Apart from the intrinsic value of the work, which is well-known to all medical German 
scholars, the translation of it has been completed in the most thorough and painstaking way ; 
and all the Latin and Greek quotations have been carefully rendered into English. The 
book itself is a work of great merit, thoroughly exhausting the whole range of the subject. 
To obtain a thorough view of the spirit of the action of the drug, we can recommend no 
better work." — North American Journal. 

RUDDOCK, DR. Principles, Practice, and Progress of Homoe- 
opathy. 5 cts. ; per hundred, $3 ; per thousand, . . $25 00 

RUSH, DR. JOHN. Veterinary Surgeon. The Handbook to Vet- 
erinary Homoeopathy; or, the Homoeopathic Treatment of Horses, 
Cattle, Sheep, Dogs, and Swine. From the London edition. With 
numerous additions from the Seventh German edition of Dr. F. E. 
Gunther's " Homoeopathic Veterinary." Translated by J. F. Sheek, 
M.D. 150 pages. i8mo. Cloth, • . . . . -5° cts. 

SCHAEFER, J. C. New Manual of Homoeopathic Veterinary 
Medicine. An easy and comprehensive arrangement of Diseases, 
adapted to the use of every owner of Domestic Animals, and especially 
designed for the Farmer living out of the reach of medical advice, and 
showing him the way of treating his sick Horses, Cattle, Sheep, Swine> 



14 BOERICKE & TAFEL'S 



and Dogs, in the most simple, expeditious, safe, and cheap manner. 
Translated from the German, with numerous Additions from other 
Veterinary Manuals, by C. J. Hempel, M.D. 321 pages. 8vo. 
Cloth, . . . . . . . . . . . $2 00 

SCHWABE, DR.WILLMAR. Pharmacopoeia Homceopathica 
Polyglottica. Second edition. Cloth, . . . . I3 00 

SHARP'S TRACTS ON HOMCEOPATHY, each, . . 5 cts. 

Per hundred, . . . . . . . . . I3 00 

No. I. What is Homoeopathy? No. 7. The Principles of Homoeopathy. 

No. 2. The Defence of Homoeopathy. No. 8. Controversy on 

No. 3. The Truth of " No. 9. Remedies of 

No. 4. The small Doses of " No. 10. Provings of 

No. 5. The Difficulties of " No. 11. Single Medicines of 

No. 6. Advantages of " No. 12. Common-sense of 

SHARP'S TRACTS. Complete set of Twelve Numbers, . 50 cts. 
Bound, 75 cts. 

SMALL, DR. A. E. Manual of Homoeopathic Practice, for the 

use of Families and Private Individuals. Fifteenth enlarged edition. 
831 pages. 8vo. Half leather, . . . . . . $2 50 

SMALL, DR. A. E. Manual of Homoeopathic Practice. Trans- 
lated into German by C. J. Hempel, M.D. Eleventh edition. 643 
pages. 8vo. Cloth, . . . . . . . $2 50 

SMALL, DR. A. E. Diseases of the Nervous System, to which 

is added a Treatise on the Diseases of the Skin, by Dr. C. E. Tooth- 

aker. 216 pages. 8vo. Cloth, . . . . . |i 00 

This treatise is from the pen of the distinguished author of the well-known and highly 
popular work entitled, " Small's Domestic Practice." It contains an elaborate description of 
the diseases of the nervous system, together with a full statement of the remedies which have 
been used with beneficial effect in the treatment of these disorders. 

STAPF, DR. E. Additions to the Materia Medica Pura. Trans- 
lated by C. J. Hempel, M.D. 292 pages. v 8vo. Cloth, . $1 50 

This work is an indispensable appendix to Hahnemann's Materia Medica Pura. Every 
remedy is accompanied with extensive and most interesting clinical remarks, and a variety of 
cases illustrative of its therapeutical uses. 

VERDI, DR. T. S. Maternity; a Popular Treatise for Young 
Wives and Mothers. By Tullio Suzzara Verdi, A.M., M.D., of 
Washington, D. C. 450 pages. i2mo. Cloth, . . . |2 00 

" No one needs instruction more than a young mother, and the directions given by Dr. 
Verdi in this work are such as I should take great pleasure in recommending to all the young 
mothers, and some of the old ones, in the range of my practice." — George E. Shipman, 
M.D., Chicago, 111. 

"Dr. Verdi's book is replete with useful suggestions for wives and mothers, and his 
medical instructions for home use accord with the maxims of my best experience in prac- 
tice." — John F. Gray, M.D., New York City. 

VERDI, DR. T. S. Mothers and Daughters ; Practical Studies for 
the Conservation of the Health of Girls. By Tullio Suzzara Verdi, 
A.M., M.D. 287 pages. i2mo. Cloth, . . . . $1 50 



HOMOEOPATHIC PUBLICATIONS. 15 

"The people, and especially the women, need enlightening on many points connected 
with their physical life, and the time is fast approaching when it will no longer be thought 
singular or ' Yankeeish ' that a woman should be instructed in regard to her sexuality, its or- 
gans and their functions. . . . Dr. Verdi is doing a good work in writing such books, 
and we trust he will continue in the course he has adopted of educating the mother and 
daughters. The book is handsomely presented. It is printed with good type on fine paper, 
and is neatly and substantially bound." — Hahnemannian Monthly. 

VON TAGEN. Biliary Calculi, Perineorrhaphy, Hospital Gan- 
grene, and its Kindred Diseases. i54pages. 8vo. Cloth, $i 25 

"Von Tagen was an industrious worker, a close observer, an able writer. The essays 
before us bear the marks of this. They are written in an easy, flowing, graceful style, and 
are full of valuable suggestions. While the essay on perineorrhaphy is mainly of interest to 
the surgeon, the other essays concern the general practitioner. They are exhaustive and 
abound in good things. The author is especially emphatic in recommending the use of bro- 
mine in the treatment of hospital gangrene, and furnishes striking clinical evidence in sup- 
port of his recommendation. 

"The book forms a neat volume of 150 pages, and is well worthy of careful study." — 
Medical Counselor. 

WILLIAMSON, DR. W. Diseases of Females and Children, 

and their Homoeopathic Treatment. Third enlarged edition. 

256 pages. i2mo. Cloth, . . . . . . $1 00 

This work contains a short treatise on the homoeopathic treatment of the diseases of fe- 
males and children, the conduct to be observed during pregnancy, labor, and confinement, 
and directions for the management of new-born infants. 

WINSLOW, DR. W. H. The Human Ear and Its Diseases. 

A Practical Treatise upon the Examination, Recognition, and Treat- 
ment of Affections of the Ear and Associate Parts, Prepared for the In- 
struction of Students and the Guidance of Physicians. By W. H. Win- 
slow, M.D., Ph.D., Oculist and Aurist to the Pittsburg Homoeopathic 
Hospital, etc., etc., with one hundred and thirty-eight illustrations. 
Boericke & Tafel : New York and Philadelphia. Pp. 526. 8vo. 
Cloth, $4 50 

"... We hail with pleasure the advent of this work. There is perhaps no branch 
in the science of medicine in which there has been so little advance as in that of otology. 

Our author has treated his subject very systematically, giving first the anatomy, then the 
physiology, as at present understood, methods of examination, morbid changes and injuries, 
and finally the therapeutics. This last is of especial value to us, as our provings are singu- 
larly deficient in reference to symptoms of the ear. . . . This book is a move in the 
right direction, and we earnestly hope it will prove a stimulus for other specialists of our 
school." — New England Medical Gazette. 

"... Moreover, he has literally crammed the work with thoughts and suggestions 
of a practical kind, such as could only be the outgrowth of a large personal experience and 
long-continued habits of close and careful observation. . . . The work is thoroughly 
practical throughout; theories are left iu the background, and the hard facts of the business 
of the otologist are portrayed with a distinctness and force which characterize all the writings 
of this author. — Hahnemannian Monthly. 

WORCESTER, DR. S. Repertory to the Modalities. In their 
Relations to Temperature, Air, Water, Winds, Weather and 
Seasons. Based mainly upon Hering's Condensed Materia Medica, 
with additions from Allen, Lippe, and Hale. Compiled and arranged 
by Samuel Worcester, M.D, Salem, Mass., Lecturer on Insanity and 
its Jurisprudence at Boston University School of Medicine, etc., etc. 
1880. 160 pages. i2mo. Cloth, . . . . . $1 25 



16 BOERICKE & TAFEL'S HOMOEOPATHIC .PUBLICATIONS. 

" This ' Repertory to the Modalities ' is indeed a most useful undertaking, and will, 
without question, be a material aid to rapid and sound prescribing where there are promi- 
nent modalities. The first chapter treats of the sun and its effects, both beneficial and hurt- 
ful, and we see at a glance that Strontium carb., Anacardium, Conium mac, and Kali bich. 
are likely to be useful to patients who like basking in the sun. No doubt many of these 
modalities are more or less fanciful ; still a great many of them are real and of vast clinical 
range. 

" The book is nicely printed, on good paper, and strongly bound. It contains only 160 
pages. We predict that it will meet with a steady, long-continued sale, and in the course of 
lime be found on the tables of most of those careful and conscientious prescribers who admit 
the philosophical value of (for instance) lunar aggravations, effects of thunder-storms, etc. 
And who, being without the priggishness of mere brute science, does not?" — Homoeo- 
pathic World. 

"WORCESTER, DR. S. Insanity and Its Treatment. Lectures 
on the Treatment of Insanity and Kindred Nervous Diseases. By 
Samuel Worcester, M.D., Salem, Mass. Lecturer on Insanity, Ner- 
vous Diseases and Dermatology, at Boston University School of Medi- 
cine, etc., etc., . . . . . . . . . $3 50 

Dr. Worcester was for a number of years assistant physician of the Butler 
Hospital for the Insane, at Providence, R. I., and was appointed shortly 
after as Lecturer on Insanity and Nervous Diseases to the Boston University 
School of Medicine. The work, comprising nearly five hundred pages, will 
be welcomed by every homoeopathic practitioner, for every physician is called 
upon sooner or later to undertake the treatment of cases of insanity among 
his patrons' families, inasmuch as very many are loth to deliver any afflicted 
member to a public institution without having first exhausted all means within 
their power to effect a cure, and the family physician naturally is the first to 
be put in charge of the case. It is, therefore, of paramount importance that 
every homoeopathic practitioner's library should contain such an indispensa- 
ble work. 

" The basis of Dr. Worcester's work was a course of lectures delivered before the senior 
students of the Boston University School of Medicine. As now presented with some altera- 
tions and additions, it makes a very excellent text-book for students and practitioners. Dr. 
Worcester has drawn very largely upon standard authorities and his own experience, which 
has not been small. In the direction of homoeopathic treatment, he has received valuable 
assistance from Drs. Talcott and Butler, of the New York State Insane Asylum. It is not, 
nor does it pretend to be, an exhaustive work ; but as a well-digested summary of our present 
knowledge of insanity, we feel sure that it will give satisfaction. We cordially recommend 
it." — New England Medical Gazette. 



JUST ISSUED! 

THE AMERICAN HOMOEOPATHIC PHARMACOPOEIA. 

Compiled and Published by Boericke & Tafel. Pp. 523, 8vo. Cloth, $3.50. 

No physician, busy or otherwise, can afford to neglecft a correct knowledge of the forms 
and preparations of his armament against disease. This knowledge is as necessary in con- 
trolling legitimate operations on part of the pharmacist, as in preparing remedies individually. 
In point of general information and especially of minute and unmistakable directions, the 
work stands alone among the recent publications on this subject. Special attention is given 
to synonyms in the body of the book, besides being fully represented in a large and copious 
index. 



S@" All the Medicines mentioned in this work can be obtained in 
their utmost purity and conscientiously prepared at 



BQERICKE k TAFEL'S 

Homeopathic Phabmac 



D 



EST^IBILISIIIEID I INT 1835. 



NEW YORK, 145 Grand St. 
PHILADELPHIA, 101 lAreh St. 

PHILADELPHIA, 1216 Girard Ave. 

BALTIMORE, 135 West Fayette -St. 
NEW ORLEANS, 130 Canal St. 

CHICAGO, 35 South Clark St. 

SAN- FRANCISCO, 234 Sutter St. 



NOTICE TO PHYSICIANS. 



Mother Tinctures. In the preparation of our Mother Tinctures, we make 
use of none but fresh, green plants, for the proper collection of which we have un- 
usual facilities. Most of these are collected by ourselves within a radius of less 
than twenty miles from Philadelphia. Plants indigenous to the West we procure 
through our branch in Chicago ; those of the South, through our branch in New 
Orleans ; while plants growing on the Pacific Coast, the Sandwich Islands, etc., 
are furnished by our branch at San Francisco. Thus saturated tinctures made 
from fresh plants, gathered when in full vigor, may at all times be relied upon. 

European Homoeopathic Tinctures we import from the best known sources, 
i. e., from reputable Homoeopathic Pharmacies. 

The only exceptions to above rule are tinctures from plants growing in distant 
countries, as Nux vom., Rheum, Ignatia, etc., which of necessity are made from 
carefully selected dry material. 

Triturations. Our Triturations are made with Pure Sugar of Milk in steam 
triturators with the latest improvements. Having ample facilities, we are enabled 
to accord to each trituration fully two hours, whereby an unusual degree of excel- 
lence is obtained. Remedies such as Sepia, Mercurius v., Graphites, are triturated 
four hours or longer, until the desired grade of comminution is secured. 

Dilutions. Our Dilutions are all conscientiously made by hand. We com- 
menced by running up one hundred remedies to the 30th, retaining all intermediate 
attenuations and using a separate box for each remedy. Gradually the list has in- 
creased until to-day we carry in stock over seven hundred remedies, and are able to 
supply any of them like the 12th, 15th, 24th, etc., as readily as the 3d or 6th. Each 
of our eight pharmacies carries such a set in stock, and our patrons thus have ab- 
solute surety of obtaining any intermediate potency called for. 

Our Pharmacies are devoted exclusively to the sale of Homoeopathic Medi- 
cines and Books; and as all Branch Establishments are supplied from our Labora- 
tory in Philadelphia, Medicines of our uniform standard quality, may be obtained 
alike from either of our establishments. 

In conclusion, we beg to assure the profession that, it has ever been our en- 
deavor to excel in the quality of our preparations ; that while furnishing our medi- 
cines at a moderate advance on cost, we do not intend to compete with establish- 
ments whose sole claims lie in cheap prices. Our endeavors have met with hearty 
acknowledgement by the profession, and the generous support accorded to our es- 
tablishments, bears witness to our ability to give satisfaction to our many patrons. 

Complete Price List and Illustrated Catalogue sent free to Physi- 
cians on application. 



~1 1 



Date betted £>w. 
1